Glycoprotein IIb/IIIa inhibitor use in patients with acute myocardial infarction undergoing PCI: Insights from the TRANSLATE ACS study.

Abstract

INTRODUCTION:

Concomitant use of glycoprotein IIb/IIIa inhibitors (GPI) and P2Y12 inhibitors increases bleeding risk. How GPIs are being used with faster onset, higher potency P2Y12 inhibitors are unclear.

METHODS AND RESULTS:

We studied 11,781 myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI) at 233 hospitals in the TRANSLATE ACS study (2010-2012). We used propensity matching to compare 6-week major adverse cardiac events (MACE: death, recurrent MI, stroke, or unplanned revascularization) and BARC 2+ bleeding events between patients who did and did not receive planned GPI. Planned and bailout GPI were used in 4,983 (42.2%) and 229 (4.4%) MI patients undergoing PCI, respectively. Patients receiving planned GPI were younger (58 vs. 61 years), more likely to present with STEMI (62.6% vs. 45.4%) or have stent thrombosis (4.2% vs. 2.1%, all P < 0.001) than those without planned GPI use. Planned GPI was used less often with prasugrel/ticagrelor versus clopidogrel (37.1% vs. 43.3%), or when any P2Y12 inhibitor was given >6 hr prior to PCI versus earlier (27.8% vs. 44.4%, both P < 0.01). After propensity matching, planned GPI use was not associated with any difference in MACE (6.4% vs. 5.5% OR 1.18; 95% CI: 0.99-1.57), however, the risk of BARC 2+ bleeding was higher in patients who received planned GPI (11.3% vs. 8.7%; OR 1.34; 95% CI: 1.13-1.59).

CONCLUSION:

Planned GPI use as reported by practicing physicians was prevalent between 2010 and 2012 and was associated with increased risk of bleeding but not lower MACE.

• Authors: Homam Ibrahim, Lisa A Kaltenbach, Connie N Hess, Tammy Recchia, Mark B Effron, Gregg W Stone, Tracy Y Wang
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 93 Issue 4 Pg. E204-E210 (03 01 2019) ISSN: 1522-726X [Electronic] United States
• PMID: 30244509 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2018 Wiley Periodicals, Inc.

Chemical References

• Fibrinolytic Agents
• P2RY12 protein, human
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Purinergic P2Y Receptor Antagonists
• Receptors, Purinergic P2Y12

Topics

• Aged
• Blood Platelets (drug effects, metabolism)
• Drug Therapy, Combination
• Female
• Fibrinolytic Agents (adverse effects, therapeutic use)
• Hemorrhage (chemically induced)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Percutaneous Coronary Intervention (adverse effects, mortality)
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors, metabolism)
• Practice Patterns, Physicians'
• Purinergic P2Y Receptor Antagonists (adverse effects, therapeutic use)
• Receptors, Purinergic P2Y12 (blood, drug effects)
• Recurrence
• Risk Factors
• Stroke (mortality)
• Time Factors
• Treatment Outcome
• United States