GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients and Definitions
2.2. Pharmacological Treatment
2.3. Study End Points
2.4. Statistical Methods
3. Results
3.1. Thirty-Day Mortality
3.2. Mortality after One Year
3.3. TIMI Grade Flow
3.4. Bleeding
3.5. Cerebral Performance Category (CPC) Score
3.6. Complications during Hospitalization
4. Discussion
- (a)
- Patients receiving GPI had significantly better TIMI flow after PCI and more often experienced an improvement of ≥ 1 TIMI grade flow during PCI.
- (b)
- GPI use was not associated with a higher bleeding rate in these patients.
- (c)
- The CPC score was better in patients with GPI.
- (d)
- Patients receiving GPI had similar 30-day and one-year mortality, and GPI were not independently associated with either outcome.
5. Conclusions
6. Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | NO-GPI N = 75 | GPI N = 78 | POPULATION N = 153 | p |
---|---|---|---|---|
Age (years) | 66.0 (12.9) | 65.1 (13.3) | 66.0 (12.9) | 0.66 |
Women | 28 (37.5) | 25 (32.1) | 53 (34.6) | 0.50 |
Diabetes | 14 (18.7) | 17 (21.8) | 31 (20.3) | 0.69 |
Hypertension | 24 (32.0) | 29 (37.2) | 53 (34.6) | 0.61 |
Hyperlipidemia | 7 (9.3) | 13 (16.7) | 20 (13.1) | 0.23 |
Smoking | 12 (16.0) | 11 (14.1) | 23 (15.0) | 0.82 |
Previous MI | 13 (17.3) | 10 (12.8) | 23 (15.0) | 0.50 |
Previous stroke | 7 (9.3) | 2 (2.6) | 9 (5.9) | 0.094 |
Previous PCI or CABG | 7 (9.3) | 2 (2.6) | 9 (5.99) | 0.094 |
Aortic stenosis | 3 (4.0) | 1 (1.3) | 4 (2.6) | 0.36 |
Known chronic kidney disease | 7 (9.3) | 4 (5.1) | 11 (7.2) | 0.36 |
STEMI | 63 (84.0) | 73 (92.3) | 136 (88.2) | 0.13 |
Anterior infarct | 34 (45.3) | 46 (59.0) | 80 (52.3) | 0.11 |
Cardiopulmonary resuscitation | 50 (66.7) | 58 (74.4) | 108 (70.6) | 0.37 |
Therapeutic hypothermia | 19 (25.3) | 37 (47.4) | 56 (36.6) | 0.007 |
Pulmonary edema | 63 (84.0) | 57 (73.1) | 120 (78.4) | 0.12 |
Hemoglobin (g/L) | 128.2 (19.9) | 130.8 (21.8) | 129.6 (19.9) | 0.055 |
Systolic pressure (mmHg) | 85.6 (25.8) | 91.5 (23.3) | 88.6 (24.7) | 0.14 |
Diastolic pressure (mmHg) | 59.4 (16.2) | 62.5 (14.2) | 61.1 15.2) | 0.23 |
Mean pressure (mmHg) | 70.6 (17.0) | 73.2 (15.7) | 72.0 (16.3) | 0.36 |
GFR (mL/min/1.73 m2) | 49.4 (30.4, 64.1) | 57.5 (44.4, 71.2) | 53.0 (35.2, 68.9) | 0.031 |
Radial access | 3 (4.0) | 2 (2.6) | 5 (3.3) | 0.68 |
PCI LMCA | 13 (17.3) | 15 (19.2) | 28 (18.3) | 0.84 |
PCI LAD | 28 (37.3) | 49 (62.8) | 77 (50.3) | 0.002 |
PCI LCX | 11 (14.7) | 22 (28.2) | 33 (21.6) | 0.05 |
PCI RCA | 12 (16.0) | 18 (23.1) | 30 (19.6) | 0.31 |
Multivessel PCI | 15 (21.1) | 26 (39.4) | 41 (29.9) | 0.025 |
Mechanical circulatory support | 16 (21.3) | 19 (24.3) | 35 (20.9) | 0.89 |
P2Y12 | 39 (52.0) | 45 (57.7) | 84 (54.9) | 0.52 |
Potent P2Y12 (prasugrel, ticagrelor) | 24 (32.0) | 26 (33.3) | 50 (32.7) | 0.86 |
Bivalirudin | 3 (4.0) | 2 (2.6) | 5 (3.3) | 0.68 |
TIMI 0/1 before PCI | 51 (68.0) | 60 (76.9) | 111 (72.5) | 0.28 |
TIMI 0/1 after PCI | 26 (34.7) | 8 (10.3) | 34 (22.2) | <0.0001 |
Tn, µg/L | 53.6 (57.2) | 63.1 (60.3) | 58.9 (58.7) | 0.44 |
EF | 31.5 (5.9) | 31.0 (4.5) | 31.2 (5.2) | 0.59 |
Bleeding | 31 (41.3) | 33 (42.3) | 64 (41.8) | 1.00 |
Bleeding in P2Y12 patients | 18 (46.2) | 21 (46.7) | 39 (46.4) | 1.00 |
Bleeding in potent P2Y12 patients | 9 (37.5) | 8 (30.8) | 17 (34.0) | 0.76 |
Acute stent thrombosis | 3 (4.0) | 1 (1.3) | 4 (2.6) | 0.36 |
CABG in the same hospitalization | 6 (8.0) | 2 (2.6) | 8 (5.2) | 0.16 |
CPC | 2.86 (1.34) | 1.57 (0.98) | 1.89 (1.19) | 0.011 |
Mortality outcome | ||||
Death 30-day | 62 (82.7) | 54 (69.2) | 116 (75.8) | 0.06 |
Death one-year | 64 (85.3) | 60 (76.9) | 124 (81.0) | 0.22 |
30-Day Mortality | One-Year Mortality | |||
---|---|---|---|---|
OR (95% CI) | p | HR (95% CI) | p | |
Age | 1.04 (0.99 to 1.08) | 0.087 | 1.01 (0.99 to 1.03) | 0.30 |
Male sex | 1.55 (0.53 to 4.50) | 0.42 | 0.87 (0.58 to 1.32) | 0.52 |
Diabetes | 0.82 (0.22 to 3.08) | 0.77 | 0.96 (0.78 to 1.57) | 0.87 |
Hypertension | 0.59 (0.18 to 1.93) | 0.38 | 1.03 (0.67 to 1.60) | 0.88 |
Hyperlipidemia | 2.30 (0.48 to 11.34) | 0.29 | 0.99 (0.56 to 1.76) | 0.98 |
GFR | 1.00 (0.98 to 1.02) | 0.99 | 1.00 (0.99 to 1.01) | 0.99 |
STEMI | 0.65 (0.10 to 4.28) | 0.66 | 1.04 (0.58 to 1.86) | 0.90 |
CPR | 1.89 (0.50 to 7.24) | 0.35 | 1.18 (0.72 to 1.92) | 0.51 |
Therapeutic hypothermia | 0.54 (0.14 to 2.11) | 0.38 | 0.74 (0.45 to 1.22) | 0.23 |
TIMI 0/1 after PCI | 1.75 (0.42 to 7.25) | 0.44 | 1.11 (0.68 to 1.80) | 0.67 |
P2Y12 | 0.08 (0.02 to 0.32) | <0.0001 | 0.66 (0.45 to 0.98) | 0.035 |
GPI | 0.53 (0.19 to 1.46) | 0.22 | 0.92 (0.62 to 1.34) | 0.70 |
Bleeding | 3.25 (1.17 to 9.05) | 0.024 | 1.15 (0.77 to 1.72) | 0.48 |
All Patients N = 153 | All Patients Receiving P2Y12 N = 84 | Patients Receiving Potent P2Y12 N = 50 | |||||||
---|---|---|---|---|---|---|---|---|---|
No-GPI | GPI | p | No-GPI | GPI | p | No-GPI | GPI | ||
TIMI flow before PCI | 0.84 (1.15) | 0.62 (0.87) | 0.17 | 0.82 (1.05) | 0.56 (0.84) | 0.20 | 0.71 (1.04) | 0.42 (0.81) | 0.28 |
TIMI flow after PCI | 1.85 (1.27) | 2.54 (0.85) | <0.0001 | 2.0 (1.26) | 2.64 (0.77) | 0.005 | 1.88 (1.33) | 2.73 (0.60) | 0.005 |
Improvement of TIMI flow ≥ 1 | 38 (50.7) | 68 (87.2) | <0.0001 | 23 (59.0) | 41 (91.1) | 0.001 | 13 (54.0) | 25 (96.2) | 0.001 |
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Kanic, V.; Kompara, G.; Suran, D. GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists. J. Clin. Med. 2022, 11, 7426. https://doi.org/10.3390/jcm11247426
Kanic V, Kompara G, Suran D. GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists. Journal of Clinical Medicine. 2022; 11(24):7426. https://doi.org/10.3390/jcm11247426
Chicago/Turabian StyleKanic, Vojko, Gregor Kompara, and David Suran. 2022. "GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists" Journal of Clinical Medicine 11, no. 24: 7426. https://doi.org/10.3390/jcm11247426