Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22215
Title: Trends of Use and Outcomes Associated With Glycoprotein-IIb/IIIa Inhibitors in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.
Authors: Gellatly, Rochelle M;Connell, Cia;Tan, Christianne;Andrianopoulos, Nick;Ajani, Andrew E;Clark, David J;Nanayakkara, Shane;Sebastian, Martin;Brennan, Angela;Freeman, Melanie;O'Brien, Jessica;Selkrig, Laura A;Reid, Christopher M;Duffy, Stephen J
Affiliation: Alfred Hospital, Melbourne, Victoria, Australia
Monash University, Melbourne, Victoria, Australia
Royal Melbourne Hospital, Parkville, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Victoria, Australia
University Hospital Geelong, Victoria, Australia
Box Hill Hospital, Victoria, Australia
Issue Date: 25-Nov-2019
EDate: 2019-11-25
Citation: The Annals of pharmacotherapy 2019; online first: 25 November
Abstract: Background: Glycoprotein IIb/IIIa inhibitors (GPIs) are a treatment option in the management of acute coronary syndromes (ACSs). Evidence supporting the use of GPIs predates trials establishing the benefits of P2Y12 inhibitors, routine early invasive therapy, and thrombectomy devices in patients with ACS. Objective: The aim of this study was to determine trends in GPI use and their associated outcomes in contemporary practice. Methods: We assessed GPI use in patients with ACS undergoing percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry (2005-2013). The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACE). The safety endpoint was in-hospital major bleeding. Results: GPIs were used in 40.5% of 12 357 patients with ACS undergoing PCI. GPI use decreased over the study period (P for trend <0.0001). Patients were more likely to receive GPIs if they were younger, presented with a ST-elevation myocardial infarction (STEMI), had more complex (B2/C-type) lesions, and when thrombectomy devices were used (all P < 0.0001). MACE were higher in patients receiving GPI (4.9% vs 4.1%, P = 0.03). Propensity score matching revealed no difference in 30-day mortality and 30-day MACE (odds ratio [OR] = 1.00; 95% CI = 0.99-1.004 and OR = 1.01; 95% CI = 0.99-1.02, respectively). GPI use was associated with more bleeding complications (3.6% vs 1.8%, P < 0.0001). Conclusion and Relevance: GPI use in ACS patients undergoing PCI has declined, and use appears to be dictated by ACS type and lesion complexity, as opposed to high-risk comorbidities. GPI use was associated with a doubling in bleeding complications.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22215
DOI: 10.1177/1060028019889550
ORCID: 0000-0002-4518-5948
PubMed URL: 31766865
Type: Journal Article
Subjects: acute coronary syndrome
bleeding
drugs
glycoprotein-IIb/IIIa inhibitors
percutaneous coronary intervention
Appears in Collections:Journal articles

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