SPC365

Glycoprotein IIb-IIIa receptor inhibitors in acute coronary syndrome patients presenting with cardiogenic shock: a nation-wide registry

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Carolina Saleiro

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Posters
FP Number: ---
Authors: Carolina Saleiro; Diana Decampos; Joana m Ribeiro; João Lopes; José p Sousa; Luis Puga; Ana rm Gomes; Carolina Lourenço; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Cardiogenic shock (CS) complicates 5-10% of the cases of myocardial infarction. In-hospital mortality still ranges from 23-44%. The use of glycoprotein IIb-IIIa (GPI) may be a valuable option in these high-risk patients given its intravenous use, high potency and rapid onset of action. </span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Data about the benefit of GPI in these patients is rather sparse and conflicting.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> To assess the prognostic impact of the adjunctive use of GPI on in-hospital and 1-year mortality in patients with acute coronary syndrome (ACS) complicated with CS undergoing percutaneous coronary intervention (PCI). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> 27578 ACS patients included in the national registry between 2010 and 2019 were retrospectively assessed. Clinical, laboratorial and echocardiographic data were evaluated. Two percent of these patients (n=357) were admitted in CS and were enrolled in our study. Two groups were created: Group A (patients undergoing PCI with adjunctive use of GPI) &ndash; N= 107 and Group B (patients undergoing PCI, not receiving GPI) &ndash; N= 250. The co-primary endpoints were in-hospital and 1-year mortality. Secondary endpoints were successful PCI, re-infarction, major bleeding, and aborted sudden cardiac death.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Demographics and CV risk factors were similar between groups. Mean age was 68&plusmn;13 years, with a male predominance (68%). Supra-ST elevation ACS patients were more likely to receive GPI (95% vs 83%, P=0.002). The culprit vessel did not differ significantly, but left main occlusion was more frequent in the GPI group (15% vs 5%, P=0.006). No differences in the antiplatelet therapy were noted. The GPI used was eptifibatide in 45%, abciximab in 41% and tirofiban in 14% of the cases. No differences between groups were noted for intra-hospital mortality - 35.5% vs 32.8% (OR 1.13, 95% CI 0.70-1.82); successful PCI - 94% vs 91% (OR 0.33, 95% CI 0.62-4.06); re-infarction - 1.9% vs 2.4% (OR 0.77, 95% CI 0.15-3.90) or major bleeding - 10.3% vs 6.4% (OR 1.68, 95% CI 0.75-3.74). Patients receiving adjunctive GPI were more likely to have an aborted sudden cardiac death - 37.4% vs 24% (OR 1.89, 95% CI 1.16-3.08). Only 70 patients had follow-up at a-year. A-year mortality was not different between groups (57% vs 43%, Log Rank P=0.28). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">In our population, the adjunctive use of GPI in the context of an ACS complicated with CS did not show benefit in short or long-term mortality. Successful PCI, re-infarction or major bleeding during the index hospitalization were also no different from patients not receiving GPI. </span></span></span></span></p>