Abstract
AimCardiac arrest is the most serious complication in acute coronary syndromes. Glycoprotein IIb/IIIa inhibitors (GPI) are used in selected acute coronary syndrome patients. If the use of GPI leads to an increase in bleeding events and influences survival in patients after cardiac arrest is unknown.MethodsWe report retrospective data of a single center registry of patients after successful intra- and out-of-hospital cardiac arrest between 2002 and 2013. Inclusion criteria were survival for at least 6 h and successful percutaneous coronary intervention (PCI) within the first 24 h. Patients treated with other fibrinolytic agents or being supported by an extracorporeal life support system were excluded from the analysis.Results310 patients were included in our study. 204 received GPI (GPI+), 106 did not (GPI−). Patients in the GPI+ group were significantly younger (62.8 vs. 68.0 years, p < 0.001) and had larger myocardial infarction sizes (maximum creatine kinase 3407 vs. 1450 U/l, p < 0.001). CPR duration, SOFA score and first lactate did not differ between the groups. Any bleeding occurred significantly more often in the GPI+ group (83.3% vs. 67.0%, p = 0.001). Decline of hemoglobin within the first 24 h was higher in the GPI+ group (−1.59 ± 1.71 mg/dl vs. −0.88 ± 1.95 mg/dl, p = 0.004), number of transfused packed red blood cells in the first 4 days, however, were similar (1.18 ± 0.40 vs. 0.90 ± 0.41 packs, p = 0.378). Survival at ICU discharge was significantly higher in the GPI+ group (77.5% vs. 63.2%, p = 0.008). The use of GPI was an independent predictor of hospital survival (OR 3.07, CI 1.31−7.20, p = 0.010). The positive effect for GPI persisted after nearest neighbor propensity score matching including 144 patients (OR 3.27, 95% CI 1.48−7.21, p = 0.003).ConclusionAfter cardiac arrest, bleeding incidence was significantly higher in patients treated with GPI. Incidence of bleedings requiring transfusion, however, was similar. In this retrospective analysis, the use of GPI was an independent predictor of hospital survival. We suggest that GPI may not be withheld from cardiac arrest survivors due to potential risk of bleeding.Graphic abstract
Highlights
Sudden cardiac death, or out-of-hospital cardiac arrest (OHCA), is one of the leading causes of death in western countries [1]
A total of 400 patients were excluded from analysis (44 for missing data, 24 for ECMO, 41 for fibrinolytic agent and 291 for unsuccessful or not performed percutaneous coronary intervention (PCI))
Bleeding scores including Acuity and Crusade were significantly lower in the Glycoprotein IIb/IIIa inhibitors (GPI)+ group at initial presentation, as calculated retrospectively
Summary
Out-of-hospital cardiac arrest (OHCA), is one of the leading causes of death in western countries [1]. Tremendous efforts are undertaken to increase survival rates by optimizing the “chain of survival”, which includes post-resuscitation care and the identification of the underlying pathology. Significant coronary disease is frequent in resuscitated patients. Early coronary angiography is recommended in patients with suspected myocardial infarction [2]. Antiplatelet therapy has to be immediately implemented after revascularization of the culprit lesion which might be difficult and delayed in an instable and intubated patient and an oral application formula of the medication. Therapeutic, mild hypothermia might foster a trend towards more bleeding [3]. Increased bleeding might be explained by reduced platelet adhesion in lower body temperature [4]
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