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Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial.

Authors
  • Tavenier, Anne H1
  • Hermanides, Renicus S1
  • Fabris, Enrico2
  • Lapostolle, Frédéric3
  • Silvain, Johanne4
  • Ten Berg, Jurrien M5
  • Lassen, Jens F6
  • Bolognese, Leonardo7
  • Cantor, Warren J8
  • Cequier, Ángel9
  • Chettibi, Mohamed10
  • Goodman, Shaun G11
  • Hammett, Christopher J12
  • Huber, Kurt13
  • Janzon, Magnus14, 15
  • Merkely, Béla16
  • Storey, Robert F17
  • Zeymer, Uwe18
  • Ecollan, Patrick4
  • Collet, Jean-Phillipe4
  • And 6 more
  • 1 Department of Cardiology, Isala, Zwolle, The Netherlands. , (Netherlands)
  • 2 Cardiovascular Department, University of Trieste, Trieste, Italy. , (Italy)
  • 3 SAMU 93, Hôspital Avícenne, Bobigny, France. , (France)
  • 4 ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France. , (France)
  • 5 Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. , (Netherlands)
  • 6 Department of Cardiology, Odense University Hospital, Odense, Denmark. , (Denmark)
  • 7 Cardiovascular Department, Azienda Ospedaliera, Toscana Sudest, Arezzo, Italy. , (Italy)
  • 8 Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Canada. , (Canada)
  • 9 Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain. , (Spain)
  • 10 Centre Hospitalo Universitaire Frantz Fanon, Blida, Algeria. , (Algeria)
  • 11 Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Canada. , (Canada)
  • 12 Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. , (Australia)
  • 13 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital , Medical School, Sigmund Freud University, Vienna, Austria. , (Austria)
  • 14 Department of Cardiology, Linköping University, Linköping, Sweden. , (Sweden)
  • 15 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. , (Sweden)
  • 16 Heart and Vascular Center, Semmelweis University, Budapest, Hungary. , (Hungary)
  • 17 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom. , (United Kingdom)
  • 18 Klinikum Ludwigshafen und Institut für Herzinfarktforschung, Ludwigshafen, Germany. , (Germany)
  • 19 Rijnstate Hospital, Arnhem, The Netherlands. , (Netherlands)
  • 20 ACTION Study Group, Statistical Unit, Lariboisière Hospital (AP-HP), Paris VII University, Paris, France. , (France)
  • 21 Kerckhoff Campus, University of Giessen, Bad Nauheim, Germany. , (Germany)
  • 22 Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands. , (Netherlands)
  • 23 Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Thrombosis and Haemostasis
Publisher
Georg Thieme Verlag KG
Publication Date
Nov 21, 2019
Identifiers
DOI: 10.1055/s-0039-1700546
PMID: 31752042
Source
Medline
Language
English
License
Unknown

Abstract

Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not been fully investigated. 1,630 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients were divided in three groups: no GPI, GPI administration routinely before primary PCI, and GPI administration in bailout situations. The primary efficacy outcome was a composite of death, myocardial infarction, urgent target revascularization, and definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass graft (CABG)-related PLATO major bleeding at 30 days. Compared with no GPI (n = 930), routine GPI (n = 525) or bailout GPI (n = 175) was not associated with an improved primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p = 0.58). After multivariate analysis, the use of GPI in bailout situations was associated with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.32-6.64; p = 0.03). However, routine GPI use compared with no GPI was not associated with a significant increase in bleeding (OR 1.78, 95% CI 0.88-3.61; p = 0.92). Use of GPIs in addition to ticagrelor in STEMI patients was not associated with an improvement in 30-day ischemic outcome. A significant increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who received GPIs in a bailout situation. Georg Thieme Verlag KG Stuttgart · New York.

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