GP IIb/IIIa receptor inhibitors were not significantly associated with reduced 30-day all-cause mortality (69.2% vs 82.7%; p=0.06) but improved TIMI flow after PCI without increasing bleeding rates.
Cohort (n=153)
Does GP IIb/IIIa receptor inhibitors improve mortality and bleeding in mechanically ventilated patients with cardiogenic shock due to myocardial infarction?
Selective use of GP IIb/IIIa receptor inhibitors may improve TIMI flow and cerebral performance in mechanically ventilated patients with MI in cardiogenic shock without increasing bleeding risk.
Absolute Event Rate: 69.2% vs 82.7%
p-value: p=0.06
Objective: To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. Methods: We retrospectively divided 153 patients into two groups (with or without GPI). Thirty-day and one-year all-cause mortality and bleeding were studied. Results: The observed 30-day and one-year all-cause mortality were similar in both groups 54 (69.2%) with GPI vs. 62 (82.7%) without GPI; p = 0.06, and 60 (76.9%) with GPI vs. 64 (85.3%) without GPI; p = 0.22, respectively. Patients with GPI suffered fewer unsuccessful PCI (TIMI 0/1 was 10% in the GPI group vs. 57% in the group without GPI), experienced more improvements in TIMI ≥ 1 flow 68 (87.2%) in the GPI group vs. 38 (50.7%) without GPI; p < 0.0001, and they achieved better cerebral performance category (CPC) scores (1.61 ± 0.99 with GPI vs. 2.76 ± 1.64 without GPI; p = 0.005). The bleeding rate was similar in patients with and without GPI 33 (42.3%) vs. 31 (41.3%): p = 1.00, in patients with P2Y12 receptor antagonists (P2Y12) 18 (46.1%) with GPI vs. 21 (46.7%) without GPI; p = 1.00, and in patients with potent P2Y12 8 (30.8%) with GPI vs. 9 (37.5%) without GPI; p = 0.77. Conclusions: Due to the study design (limited sample size, retrospective inclusion with high risk of selection bias), our analysis does not allow us to draw conclusions about the effectiveness of GPI in this context. Despite all these limitations, GPI were associated with improved TIMI flow after PCI in our multivariable model without increasing bleeding rates. In addition, better CPC scores were observed, but no association between GPI and outcome was found. Our analysis suggests that selective use of GPI may be beneficial in mechanically ventilated patients with MI in CS without additional bleeding risk, even in the era of potent P2Y12.
Kanič et al. (Wed,) conducted a cohort in Cardiogenic shock due to myocardial infarction (n=153). GP IIb/IIIa receptor inhibitors (GPI) vs. Without GPI was evaluated on 30-day all-cause mortality (p=0.06). GP IIb/IIIa receptor inhibitors were not significantly associated with reduced 30-day all-cause mortality (69.2% vs 82.7%; p=0.06) but improved TIMI flow after PCI without increasing bleeding rates.
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