Conservative vs. Liberal Glycoprotein IIb-IIIa Antagonist Strategies in the Treatment of ST-Elevation Myocardial Infarction: A Dual-Center Analysis

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Abstract Background While the efficacy of GpIIb-IIIa-inhibitors during primary PCI (pPCI) for ST-elevated myocardial infarction (STEMI) has previously been demonstrated, its ongoing role and safety in combination with newer P2Y12-inhibitors is unclear. We therefore sought to compare outcomes between two centers with divergent approaches to the use of GpIIbIIIa antagonists in pPCI. Methods We performed a retrospective chart review of all-comer STEMI patients treated with pPCI at two high-volume Montreal academic tertiary care centers. One center tended to use GpIIb-IIIa-inhibitors up-front in a large proportion of patients (liberal strategy) and the other preferring a bail-out approach (conservative strategy). Baseline patient characteristics and procedural data were compared between the two groups. The main efficacy outcome was rate of no-reflow/slow-reflow and the main safety outcome was BARC ³ 2 bleeding events. Results A total of 459 patients were included, of whom 167 (36.5%) were exposed to a GpIIb-IIIa-antagonist. There was a significant overall difference in use of GpIIb-IIIa-antagonist between the two centers (60.5% vs 16.1%, p<0.01) Rate of no-reflow/slow-reflow was similar between groups (2.6% vs 1.4%, p=0.22). In-hospital rates of unplanned revascularization, stroke and death were aslo not different between groups. Use of a liberal GpIIb-IIIa-antagonist strategy was associated with a higher risk of bleeding (OR 3.16, p<0.01), which persisted after adjustment for covariables (adjusted OR 2.85, p<0.01). Conclusions In this contemporary retrospective cohort, a conservative GpIIb-IIIa-antagonist strategy was associated with a lower incidence of clinically relevant bleeding without any signal for an increase in no-reflow/slow-reflow or ischemic clinical events.

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