Abstract 14046: Heparin Alone is Not Enough. Gp IIb/IIIa Inhibitors Improve Outcome in Patients With Primary PCI for STEMI Treated With Heparin. Results of the Prospective ALKK-Registry

Abstract

Background: There is still debate about the optimal antithrombotic therapy in patients undergoing primary PCI. Earlier randomized trials have shown a benefit of GP IIb/IIIa inhibitors in patients treated with heparin, with the highest benefit in high risk patients. Most recent trials did not support the earlier data. Therefore we evaluated the impact of GP IIb/IIIa inhibitors on outcome in patients with primary PCI for STEMI in real life in a large number of patients. Methods: We used the data of the ongoing prospective ALKK-PCI registry and included patients with PCI for STEMI < 24 h duration treated with heparin in 40 centres. We excluded patients who were treated with bivalirudin. Results: Between 2008 and 2012 a total of 15061 consecutive patients with PCI for STEMI without cardiogenic shock were included. Of these 8864 (58.9 %) received a GP IIb/IIIa inhibitor. Baseline characteristics, procedural features and in-hospital outcomes are given in the table. In a multivariate analysis GP IIb/IIIa inhibitors were associated with a reduced mortality (odds ratio 0.81, 95% CI 0.72-0.96). Conclusion: In clinical practice GP IIb/IIIa inhibitors are used in more than 50% of the patients with primary PCI for STEMI treated with heparin. The use is associated with an improved mortality without an increase in bleeding complications. This data support the results of randomized clinical trials and questions the use of heparin alone as intravenous antithrombotic agent.