AIMS: Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries. METHODS AND RESULTS: Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry). CONCLUSIONS: Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.

2nd Department of Medicine with Cardiology and Intensive Care Hospital Rudolfstiftung Vienna Austria

AMIS Plus Data Center Epidemiology Biostatistics and Prevention Institute University of Zurich Zurich Switzerland

AMIS Plus Data Center University of Zurich Zurich Switzerland

Cardiac Intensive Care Unit Interventional Cardiology Hopital Cardiologique Centre Hospitalier Régional et Universitaire de Lille Lille France

Cardiocenter 3rd Faculty of Medicine Charles University Prague Czech Republic

Cardiology Department Hospital La Paz IdiPaz Madrid Spain

Cardiology Freeman Hospital and Institute of Cellular Medicine Newcastle Upon Tyne UK

Cardiology Service Hospital Universitari de Tarragona Joan XXIII IISPV Tarragona Spain

Cardiology Service Hospital Universitari Vall d'Hebron Barcelona Spain

Cardiology Unit Humanitas Research Hospital Rozzano Italy

Department of Cardiology Hospital Europeen Georges Pompidou AP HP Paris France Université Paris Descartes Paris France

Department of Cardiology Leiden University Medical Center Leiden The Netherlands

Department of Cardiology Lund University Skåne University Hospital Lund Sweden

Department of Cardiology Skåne University Hospital Lund Sweden

Department of Cardiology University Heart Center University Hospital Zurich University of Zurich Zurich Switzerland

Department of Cardiology University Hospital Antwerp Edegem Belgium

Department of Cardiovascular Sciences Laboratory of Interventional Cardiology European Hospital Rome Italy

Heart Disease Institute Bellvitge University Hospital IDIBELL University of Barcelona Barcelona Spain

Interventional Cardiology Institut für Herzinfarktforschung Ludwigshafen Germany

Pôle de l'urgence Service de SAMU du Nord Centre Hospitalier régional Universitaire de Lille Lille France

Swansea University College of Medicine Swansea Wales UK

Université Paris 06 ACTION Study Group INSERM UMRS 1166 Institut de Cardiologie Pitié Salpêtrière University Hospital Paris France

University Clinic of Internal Medicine 3 Cardiology and Angiology Medical University of Innsbruck Innsbruck Austria

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