Glycoprotein IIb/IIIa inhibitor use in cardiogenic shock complicating myocardial infarction: The Portuguese Registry of Acute Coronary Syndromes

Abstract

Introduction and objectives: Cardiogenic shock (CS) complicates 5–10% of cases of myocardial infarction (MI). Whether glycoprotein IIb/IIIa inhibitors (GPIs) are beneficial in these patients is controversial. Our aim is to assess the prognostic impact of GPI use on in-hospital mortality and outcomes in patients with MI and CS undergoing percutaneous coronary intervention (PCI). Methods: Between October 2010 and December 2019, 27 578 acute coronary syndrome (ACS) patients were included in the multicenter Portuguese Registry of Acute Coronary Syndromes. Of these, 357 with an MI complicated by CS were included in the analysis and grouped based on whether they received GPI therapy (with GPI, n=107 and without GPI, n=250). The primary endpoint was in-hospital mortality. Secondary endpoints included successful PCI and in-hospital reinfarction and major bleeding. Results: Demographics and cardiovascular risk factors did not differ between groups. ST-elevation MI patients were more likely to receive GPIs (95% vs. 83%, p=0.002). In-hospital mortality was similar between groups (OR 1.80, 95% CI 0.96–3.37). Only age and the use of inotropes or intra-aortic balloon pump were predictors of mortality. Also, no differences between groups were noted for successful PCI (OR 0.33, 95% CI 0.62–4.06), reinfarction (OR 0.77, 95% CI 0.15–3.90), or major bleeding (OR 1.68, 95% CI 0.75–3.74). Conclusion: The use of GPIs in the context of MI with CS did not significantly impact in-hospital outcomes. Resumo: Introdução e objetivos: O choque cardiogénico (CC) complica 5-10% dos enfartes agudos do miocárdio (EAM). O benefício do uso de inibidores da glicoproteína IIb/IIIa (GPI) nestes doentes é controverso. O nosso objetivo é avaliar o impacto prognóstico do uso de GPI nos outcomes intra-hospitalares em doentes com EAM e CC submetidos a intervenção coronária percutânea (ICP). Métodos: Entre outubro de 2010 e dezembro de 2019, 27 578 doentes com síndrome coronária aguda (SCA) foram incluídos no Registo Português de SCA. Destes, 357 com EAM complicado por CC foram incluídos. Dois grupos foram criados, baseados no facto de terem recebido terapêutica com GPI (GPI, N=107 e sem tratamento com GPI, N=250). O endpoint primário foi a mortalidade intra-hospitalar. Endpoints secundários incluíram sucesso de ICP, re-enfarte e hemorragia major. Resultados: As características demográficas e os fatores de risco cardiovasculares não diferiram entre grupos. Doentes com EAM com supra-ST receberam mais terapêutica com GPI (95% versus 83%, P=0,002). A mortalidade intra-hospitalar foi similar entre grupos (OR 1,80, 95% CI 0,96-3,37, P=0,068). Apenas a idade, uso de inotrópicos ou balão intra-aórtico foram preditores de mortalidade. Não houve diferenças para sucesso de ICP (OR 0,33, 95% CI 0,62-4,06); re-enfarte (OR 0,77, 95% CI 0,15-3,90) ou hemorragia major (OR 1,68, 95% CI 0,75-3,74). Conclusão: O uso de GPI no contexto de EAM com CC não teve impacto significativo nos outcomes intra-hospitalares.

Keywords

• Enfarte agudo do miocárdio
• Choque cardiogénico
• Inibidores da glicoproteína IIb/IIIa