Рациональная фармакотерапия в кардиологии (Jul 2024)
Use of glycoprotein IIb/IIIa inhibitors in myocardial infarction in the Russian Federation, according to the Russian Registry of Acute Myocardial Infarction REGION-IM
Abstract
Aim. To analyze the frequency, indications, and outcomes of using glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction (AMI) in Russia based on data from a multicenter registry.Material and methods. This work is part of the REGION-MI (Russian Registry of Acute Myocardial Infarction) multicenter retrospective-prospective observational study, which included patients admitted to hospitals in 45 regions of Russia with a diagnosis of AMI from 2020 to 2023. The decision to prescribe glycoprotein IIb/IIIa inhibitors was made by physicians. The observation period was 12 months, the following outcomes were recorded: cardiovascular events (relapse/repeated AMI, stent thrombosis, revascularisation), hemorrhagic complications, and in-hospital and all-cause mortality during the entire observation period. The study is conducted on the "Quinta" platform. Statistical data processing was performed using IBM SPSS Statistics ver.24.Results. A total of 10,884 patients were included in the registry, glycoprotein IIb/IIIa inhibitors were prescribed to 114 patients (1%), all of whom underwent percutaneous coronary intervention (PCI), while among patients with non-ST elevation myocardial infarction, the frequency of IIb/IIIa inhibitors was 0.5%, among ST-segment elevation myocardial infarction patients — 1.3%. Eptifibatide was used most often (67.5%), tirofiban was prescribed in 28.9% of cases, abciximab — 2.6%, framon — 0.9%. The most common indication for prescribing drugs were complications of PCI, in particular — distal embolism. There was a higher incidence of cardiogenic shock and multivessel revascularization in the glycoprotein IIb/IIIa inhibitor group. In-hospital mortality and adverse events within 180 days (death, cardiovascular events) did not differ between patients who did and did not receive glycoprotein IIb/IIIa inhibitors. The use of glycoprotein IIb/IIIa inhibitors in this study was associated with an increased risk of all in-hospital bleeding (odds ratio 9.656, confidence interval 2.859-3,894, p <0.001). Other predictors of in-hospital bleeding were: prescription of glycoprotein IIb/IIIa inhibitors, chronic kidney disease with glomerular filtration rate <60 ml/min/1.73 m2, body weight less than 60 kg.Conclusion. We observed a very low frequency of glycoprotein IIb/IIIa inhibitors usage in Russia, while these drugs are used mainly for complications of PCI in the group of patients with the highest risk — with cardiogenic shock, multivessel revascularisation, and complications of the procedure, which can have impact on the outcomes. Further research is needed to develop an optimal protocol for glycoprotein IIb/IIIa inhibitors administration in AMI.
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