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15 Clinical outcomes in patients treated with glycoprotein IIB/IIIA inhibitors during primary percutaneous coronary intervention according to arterial access site
  1. Arvindra Krishnamurthy1,
  2. Claire Keeble2,
  3. Michelle Anderson1,
  4. Kathryn Somers1,
  5. Natalie Burton-Wood1,
  6. Charlotte Harland1,
  7. Paul Baxter2,
  8. James McLenachan1,
  9. Jonathan Blaxill1,
  10. Daniel Blackman1,
  11. Christopher Malkin1,
  12. Stephen Wheatcroft2,
  13. John Greenwood2
  1. 1Leeds General Infirmary
  2. 2University of Leeds

Abstract

Background There are little available contemporary real-world data in the era of third-generation P2Y12-receptor inhibitors, examining the association between glycoprotein IIb/IIIa inhibitors (GPI) and outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI), according to arterial access site.

Objectives We sought to investigate this association in a contemporary cohort of real-world patients.

Methods Clinical and follow-up data for all patients undergoing PPCI in Leeds General Infirmary between 01–01–2009 and 31–12–2011, and 01–01–2013 and 31–12–2013 were collected prospectively. Patients included in this analysis had pre-procedural Thrombolysis in Myocardial Infarction (TIMI)−0 flow and post-procedural TIMI-3 flow in their infarct-related artery. Clinical endpoints were 30 day and 12 month mortality, and 30 day HORIZONS-major bleeding. Patients were analysed according to arterial access site with Cox-regression models, to assess the association between GPI use and outcomes in each group (transfemoral PPCI and transradial PPCI), adjusting for confounding variables.

Abstract 15 Table 1 Clinical outcomes in patients treated with glycoprotein IIb/IIIa-inhibitors according to arterial access site. Data are expressed in n (%); HR: Hazard ratio; CI: Confidence interval; *p-value 0.05

Results A total of 2369 patients were included in this analysis, of whom 821 (34.7%) underwent transfemoral PPCI and 1548 (65.3%) underwent transradial PPCI (Figure 1). GPI was used in 169 (20.6%) patients undergoing transfemoral PPCI, and 179 (11.6%) patients undergoing transradial PPCI. In transfemoral PPCI, GPI use was independently associated with 30 day mortality (HR 2.04 (1.05–3.94); p=0.03) and 30 day bleeding (HR 2.05 (1.07–3.93); p=0.03), particularly arterial access site bleeding (HR 2.71 (1.00–7.37); p=0.05), with no significant difference in 12 month mortality (HR 1.48 (0.82–2.67); p=0.20) (Table 1; Figures 2 (A)-(C)). However, in transradial PPCI, GPI use was not associated with 30 day (HR 1.27 (0.39–4.16); p=0.69) or 12 month (HR 1.21 (0.58–2.51); p=s0.62) mortality, or 30 day bleeding (HR 1.93 (0.73–4.76); p=0.16) (Figures 3 (A)-(C)).

Conclusion In transfemoral PPCI, GPI use was independently associated with worse 30 day mortality and 30 day bleeding, particularly access-site bleeding. This association was not observed in transradial PPCI.

Abstract 15 Figure 1 Inclusion algorithm for this study

Abstract 15 Figure 2 Adjusted outcomes of GPI-treated patients undergoing transfemoral PPCI (2(A)-(C)); Transradial PPCI (3(A)-(C))

  • myocardial infarction
  • percutaneous coronary intervention
  • mortality

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