One-Year Outcome of Glycoprotein IIb/IIIa Inhibitor Therapy in Patients with Myocardial Infarction-Related Cardiogenic Shock.

Krzysztof Myrda,Mariusz Gąsior,Dariusz Dudek,Marek Grygier,Wojciech Wojakowski,Bartłomiej Nawrotek,Adam Witkowski,Jacek Niedziela,Marek Gierlotka,Jacek Legutko,Maciej Lesiak,Janina Stępińska

doi:10.3390/jcm10215059

Abstract

Background: We aimed to evaluate the effect of intravenous glycoprotein IIb/IIIa receptor inhibitors (GPIs) on in-hospital survival and mortality during and at the 1-year follow-up in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) complicated by cardiogenic shock (CS), who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). Methods: From 2003 to 2019, 466,566 MI patients were included in the PL-ACS registry. A total of 10,193 patients with CS received PCI on admission. Among them, GPIs were used in 3934 patients. Results: The patients treated with GPIs were younger, had lower systolic blood pressure on admission, required inotropes and intra-aortic balloon pump (IABP) support more frequently, and showed a lower efficacy of coronary angioplasty. In both groups, the same rates of in-hospital adverse events were observed. A lower mortality rate was reported in the group treated with GPIs 12 months after admission (54.9% vs. 57.9%, p = 0.002). Therapy with GPI was an independent factor reducing the risk of mortality in the 12-month follow-up. Conclusions: The addition of GPIs to the standard pharmacotherapy combined with PCI in patients with MI and CS on admission reduced the risk of death in the 12-month follow-up period without increasing in-hospital adverse event rates.

Highlights

According to the available knowledge and current guidelines, the management of patients with myocardial infarction (MI)-related cardiogenic shock (CS) should first include an early invasive strategy with restoration of infarct-related artery (IRA) patency
10,193 MI patients with CS on admission were enrolled in the analysis
After percutaneous coronary intervention (PCI), oral anti-platelet drugs were used in this group

Summary

Introduction

According to the available knowledge and current guidelines, the management of patients with myocardial infarction (MI)-related cardiogenic shock (CS) should first include an early invasive strategy with restoration of infarct-related artery (IRA) patency The implementation of this strategy significantly reduces the risk of in-hospital and long-term mortality [1,2,3]. The increase in the doses of drugs to achieve therapeutic activity may in turn translate into a higher risk of adverse events [6] In such cases, intravenous medications such as cangrelor or glycoprotein IIb/IIIa receptor inhibitors (GPIs) may be desirable adjuncts [2,3,9,10]. Results: The patients treated with GPIs were younger, had lower systolic blood pressure on admission, required inotropes and intra-aortic balloon pump (IABP) support more frequently, and showed a lower efficacy of coronary angioplasty In both groups, the same rates of in-hospital adverse events were observed. Conclusions: The addition of GPIs to the standard pharmacotherapy combined with PCI in patients with MI and CS on admission reduced the risk of death in the 12-month follow-up period without increasing in-hospital adverse event rates

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