Glycoprotein IIb/IIIa Inhibition in Acute Coronary Syndrome
What is the impact of glycoprotein IIb/IIIa inhibition (GPI) on outcome of contemporary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS)?
The authors used the National Cardiovascular Data Registry CathPCI Registry data to assess the association between GPI use and PCI outcomes for ACS patients in the registry between July 2009 and September 2011. The primary outcome was all-cause in-hospital mortality. The secondary outcome was major bleeding.
The study population included 970,865 patients, of whom GPIs were used in 326,283 (33.6%). In unadjusted analysis, patients treated with GPIs had higher mortality (2.4% vs. 1.4%) and more bleeding (3.7% vs. 1.5%). After adjusting for nonrandom use of GPI, their use was associated with lower mortality (relative risk [RR], 0.72; 95% confidence interval [CI], 0.50-0.97) with instrumental variable analysis, as well as with propensity matching (RR, 0.90; 95% CI, 0.86-0.95). The association of GPI use with bleeding was consistently observed in adjusted analyses (multivariable relative risk, 1.93; 95% CI, 1.83-2.04). Subgroup analysis revealed enhanced risk reduction in patients with high predicted mortality.
The authors concluded that GPI use is associated with a reduction in mortality among patients undergoing PCI for ACS.
The optimal antithrombotic and antiplatelet therapy for ACS continues to be debated. There is little doubt that GPIs reduce ischemic complications, but this is at the cost of increased bleeding. The use of radial access and limiting GPI use to the catheterization laboratory only can help mitigate some of the bleeding hazard and might help improve the risk/benefit ratio of these agents in patients with ACS undergoing PCI.
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