PDF(Pubmed)
Abstract：
While the efficacy of GpIIb-IIIa-inhibitors during primary PCI (pPCI) for ST-elevated myocardial infarction (STEMI) has previously been demonstrated, its ongoing role and safety in combination with newer P2Y12-inhibitors is unclear. We therefore sought to compare outcomes between two centers with divergent approaches to the use of GpIIbIIIa antagonists in pPCI. We performed a retrospective chart review of all-comer STEMI patients treated with pPCI at two high-volume Montreal academic tertiary care centers. One center tended to use GpIIb-IIIa-inhibitors up-front in a large proportion of patients (liberal strategy) and the other preferring a bail-out approach (conservative strategy). Baseline patient characteristics and procedural data were compared between the two groups. The main efficacy outcome was rate of no-reflow/slow-reflow and the main safety outcome was BARC ≥ 2 bleeding events. A total of 459 patients were included, of whom 167 (36.5%) were exposed to a GpIIb-IIIa-antagonist. There was a significant overall difference in use of GpIIb-IIIa-antagonist between the two centers (60.5% vs. 16.1%, p < 0.01). Rate of no-reflow/slow-reflow was similar between groups (2.6% vs. 1.4%, p = 0.22). In-hospital rates of unplanned revascularization, stroke and death were also not different between groups. Use of a liberal GpIIb--IIIa-antagonist strategy was however associated with a higher risk of bleeding (OR 3.16, 95% CI 1.57-6.37, p < 0.01), which persisted after adjustment for covariables (adjusted OR 2.85, 95% CI 1.40-5.81, p < 0.01). In this contemporary retrospective cohort, a conservative, bail-out only GpIIb--IIIa-antagonist strategy was associated with a lower incidence of clinically relevant bleeding without any signal for an increase in no-reflow/slow-reflow or ischemic clinical events.
摘要：
虽然GpIIb-IIIa抑制剂在原发性PCI（pPCI）治疗ST段抬高型心肌梗死（STEMI）期间的疗效已得到证实，其与新型P2Y12抑制剂联合使用的持续作用和安全性尚不清楚.因此，我们试图比较两个中心在pPCI中使用GpIIbIIIa拮抗剂的不同方法的结果。我们在两个大批量的蒙特利尔学术三级护理中心对接受pPCI治疗的所有STEMI患者进行了回顾性图表回顾。一个中心倾向于在很大一部分患者中预先使用GpIIb-IIIa抑制剂（宽松策略），另一个中心则倾向于采用纾困方法（保守策略）。比较两组患者的基线特征和手术数据。主要疗效结果为无复流/缓慢复流率，主要安全性结果为BARC≥2次出血事件。共纳入459名患者，其中167人（36.5％）暴露于GpIIb-IIIa拮抗剂。两个中心之间使用GpIIb-IIIa拮抗剂的总体差异显着（60.5％vs.16.1%,p<0.01)。两组之间的无回流/缓慢回流率相似（2.6％vs.1.4%,p=0.22）。非计划血运重建的住院率，卒中和死亡在组间也没有差异.然而，使用宽松的GpIIb-IIIa拮抗剂策略与较高的出血风险相关（OR3.16，95％CI1.57-6.37，p<0.01），在校正协变量后仍然存在(校正后OR2.85，95%CI1.40-5.81，p<0.01)。在这个当代的回顾性队列中，一个保守派,仅释放GpIIb-IIIa拮抗剂策略与临床相关出血发生率较低相关,且无任何信号表明无复流/慢复流或缺血性临床事件增加.
