Abstract
Background: Glycoprotein IIb/IIIa inhibitors (GPI) are still used in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), although discussion about its clinical benefit is ongoing. Methods: GPI use was analyzed in this subanalysis of the POPular Genetics trial, which randomized STEMI patients to CYP2C19 genotype-guided treatment (clopidogrel or ticagrelor) or standard treatment with ticagrelor/prasugrel. The composite thrombotic endpoint consisted of cardiovascular death, myocardial infarction (MI), definite stent thrombosis, and stroke at 30 days. The combined bleeding endpoint consisted of Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding at 30 days. Univariable and multivariable analyses in addition to a propensity score-matched (PSM) analysis were conducted. Results: In total, 2378 patients, of whom 1033 received GPI and 1345 did not, were included. In multivariable analysis, GPI administration was associated with fewer thrombotic events (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.09–0.55) and MIs (HR 0.24, 95% CI 0.08–0.73). Furthermore, GPI administration was associated with an increase in bleedings (HR 2.02, 95% CI 1.27–3.19), driven by minor bleedings (HR 2.32, 95% CI 1.43–3.76), without a significant difference in major bleedings (HR 0.69, 95% CI 0.19–2.57). In the PSM analysis, no significant association was found. Conclusion: In STEMI patients undergoing primary PCI, GPI administration was associated with a reduction in thrombotic events at a cost of an increase in (mostly minor) bleedings in multivariable analysis, while propensity score analysis did not show significant associations.
| Original language | English |
|---|---|
| Pages (from-to) | 676-685 |
| Number of pages | 10 |
| Journal | Catheterization and Cardiovascular Interventions |
| Volume | 99 |
| Issue number | 3 |
| Early online date | 7 Jul 2021 |
| DOIs | |
| Publication status | Published - 15 Feb 2022 |
| Externally published | Yes |
Bibliographical note
Funding Information:The authors thank Pim van der Harst, MD, PhD, Emanuele Barbato, MD, PhD, Carmine Morisco, MD, PhD, Melvyn Tjon Joe Gin, MD, Folkert Asselbergs, MD, PhD, Arend Mosterd, MD, PhD, Jean‐Paul Herrman, MD, PhD, and Willem Dewilde, MD, PhD, for their efforts in conducting this trial. The POPular Genetics trial was conducted with a government grant from The Netherlands Organisation for Health Research and Development (project number 171102022). Spartan Bioscience Inc. (Ottawa, Canada) provided the point‐of‐care system and testing reagents used for free.
Funding Information:
Dr Arnoud W. J. van 't Hof reports grants from Medtronic and Sanofi, grants and personal fees from Astra Zeneca, and personal fees from AMGEN, outside the submitted work. Dr Daniel M. F. Claassens, Dr Gerrit J. A. Vos, Dr Thomas O. Bergmeijer, Dr Vera H. M. Deneer, and Dr Johannes C. Kelder report a grant from ZonMW and nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Renicus S. Hermanides reports nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Jurriën M. ten Berg reports grants and personal fees from AstraZeneca and personal fees from Daiichi Sankyo, Eli Lilly, Medicines Company, Accumetrics, Boehringer‐Ingelheim, Bayer, BMS, Pfizer, and Ferrer, outside the submitted work. All other authors report no potential conflict of interest.
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
Funding
The authors thank Pim van der Harst, MD, PhD, Emanuele Barbato, MD, PhD, Carmine Morisco, MD, PhD, Melvyn Tjon Joe Gin, MD, Folkert Asselbergs, MD, PhD, Arend Mosterd, MD, PhD, Jean‐Paul Herrman, MD, PhD, and Willem Dewilde, MD, PhD, for their efforts in conducting this trial. The POPular Genetics trial was conducted with a government grant from The Netherlands Organisation for Health Research and Development (project number 171102022). Spartan Bioscience Inc. (Ottawa, Canada) provided the point‐of‐care system and testing reagents used for free. Dr Arnoud W. J. van 't Hof reports grants from Medtronic and Sanofi, grants and personal fees from Astra Zeneca, and personal fees from AMGEN, outside the submitted work. Dr Daniel M. F. Claassens, Dr Gerrit J. A. Vos, Dr Thomas O. Bergmeijer, Dr Vera H. M. Deneer, and Dr Johannes C. Kelder report a grant from ZonMW and nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Renicus S. Hermanides reports nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Jurriën M. ten Berg reports grants and personal fees from AstraZeneca and personal fees from Daiichi Sankyo, Eli Lilly, Medicines Company, Accumetrics, Boehringer‐Ingelheim, Bayer, BMS, Pfizer, and Ferrer, outside the submitted work. All other authors report no potential conflict of interest.
Keywords
- clopidogrel
- glycoprotein IIb/IIIa inhibitors
- primary percutaneous coronary intervention
- STEMI
- ticagrelor