Association Between Platelet Glycoprotein IIb/IIIa Inhibition and In-Hospital Outcomes in ST-Elevation Myocardial Infarction Patients Treated with Coronary Thrombus Aspiration: Findings from the CCC-ACS Project

Wennan Liu, Ziping Li, Tianqi Yang, Geru A, Haonan Sun, Hangkuan Liu, Xiwen Song, Zhengyang Jin, Linjie Li, Yongle Li, Yongchen Hao, Jing Liu, Dong Zhao, Xin Zhou, Qing Yang
2022 · doi:10.21203/rs.3.rs-1949081/v1
preprint OA: closed CC-BY-4.0
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Abstract

Abstract Purpose: Thrombus aspiration in ST-elevation myocardial infarction (STEMI) with high thrombus burden did not improve clinical outcomes. The clinical efficacy of bailout use of platelet glycoprotein IIb/IIIa inhibitors (GPIs) in this clinical scenario remains unknown. Methods: We assessed associations between GPI use and in-hospital major bleeds, ischemic events, and mortality among STEMI patients treated with percutaneous coronary intervention (PCI) and thrombus aspiration in a nationwide acute coronary syndrome registry (the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project). Results: A total of 5,896 STEMI patients who received thrombus aspiration were identified, among which 56.3% received GPI therapy. In a 1-to-1 propensity-score-matched cohort, compared with STEMI patients not treated with GPI, GPI use was associated with a 69% increase in major in-hospital bleeds, with an odds ratio (OR) of 1.69, a 95% confidence interval (CI) of 1.08 to 2.65, and a nonsignificant reduction in ischemic events (OR: 0.61, 95% CI: 0.36 to 1.06), as well as a neutral effect on mortality (OR: 0.93, 95% CI: 0.55 to 1.58). However, among patients aged < 65 years, GPI use was associated with a reduction in ischemic events (OR: 0.26, 95% CI: 0.08 to 0.77), and no significant increase in major bleeds (OR: 1.23, 95% CI: 0.67 to 2.25) was observed. Conclusion: In a nationwide registry, routine use of GPI following thrombus aspiration was not associated with reduced in-hospital ischemic events and mortality, but at the cost of increased major bleeding. However, for patients aged < 65 years, there may be a potential net benefit.

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