Key result
Prolonging GP IIb/IIIa inhibitor infusion to ≥24 hours did not significantly improve in-hospital MACE compared to <24 hours (5.48% vs. 1.85%; p=0.394) in STEMI patients with no-/slow-reflow.
Why the study?
In patients with STEMI undergoing pPCI complicated by the no-/slow-reflow phenomenon, the optimal maintenance duration of GP IIb/IIIa inhibitors remains controversial.
Does GP IIb/IIIa inhibitor infusion for ≥ 24 hours improve MACE in STEMI patients with no-/slow-reflow undergoing primary PCI compared to < 24 hours?
Cohort (n=127)
Yes
Does GP IIb/IIIa inhibitor infusion for ≥ 24 hours improve MACE in STEMI patients with no-/slow-reflow undergoing primary PCI compared to < 24 hours?
Absolute Event Rate: 5.48% vs 1.85%
p-value: p=0.394
Prolonging GP IIb/IIIa inhibitor infusion beyond 24 hours does not significantly improve clinical outcomes in STEMI patients with no-/slow-reflow after primary PCI.
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) accompanied by the no-/slow-reflow phenomenon, the maintenance duration of GP IIb/IIIa inhibitor (GPI) is controversial. We compare the efficacy and safety of short- and long-term GPI infusion in STEMI patients with the no-/slow-reflow phenomenon. METHODS: From June 2016 to December 2019, we continuously included patients with on-set STEMI who underwent pPCI, accompanied by the no-/slow-reflow, during interventional procedures at Guangdong Provincial People's Hospital and Zhuhai Golden Bay Hospital. The hemorrhage events, heart function, and major adverse cardiovascular events (MACE) were compared between < 24 h and ≥ 24 h GPI duration groups. The Kaplan-Meier curve was used to estimate the 1-year MACE-free survival at different GPI utility times. RESULTS: In total, 127 patients were divided into two groups based on the duration of tirofiban use (less and more than 24 h). There was no significant difference between two groups in terms of baseline characteristics, plaque condition, and coronary physiological function. The two groups showed similar in-hospital MACE (1 [1.85%] vs. 4 [5.48%], p = 0.394) and 1-year MACE-free survival (log-rank test p = 0.9085). The 1-year MACE remained consistent between the two groups in all subgroups of different risk factors of no-/slow-reflow. There was no significant difference in heart function and in-hospital hemorrhage events (3.7% vs. 1.37%, p = 0.179). CONCLUSION: In the real world, prolonging the duration of GPI may not significantly improve the clinical outcome in patients with STEMI with no-/slow-reflow.
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Hu et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) with no-/slow-reflow phenomenon (n=127). Prolonged GP IIb/IIIa inhibitor infusion (≥ 24 h) vs. Short-term GP IIb/IIIa inhibitor infusion (< 24 h) was evaluated on In-hospital major adverse cardiovascular events (MACE) (p=0.394). Prolonging GP IIb/IIIa inhibitor infusion to ≥24 hours did not significantly improve in-hospital MACE compared to <24 hours (5.48% vs. 1.85%; p=0.394) in STEMI patients with no-/slow-reflow.
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