Safety and benefit of Glycoprotein IIb/IIIa inhibitors in out of hospital cardiac arrest patients treated with percutaneous coronary intervention

RESUSCITATION

卷:157

Article

Picard, Fabien^1,2,3  Sokoloff, Anastasia¹  Pham, Vincent¹  Diefenbronn, Marine¹  Laghlam, Driss¹  Seret, Gabriel¹  Varenne, Olivier^1,2  Dumas, Florence^2,3,4  Cariou, Alain^2,3,5 

[1] Cochin Hosp, Hoitaux Univ Paris Ctr, AP HP, Dept Cardiol, 27 Rue Faubourg St Jacques, F-75014 Paris, France

[2] Univ Paris, Fac Med, Paris, France

[3] Hop Europeen Georges Pompidou, Paris Cardiovasc Res Ctr PARCC, INSERM U970, Paris, France

[4] Cochin Hosp, Hop Univ Paris Ctr, AP HP, Emergency Dept, Paris, France

[5] Cochin Hosp, Hop Univ Paris Ctr, AP HP, Med Intens Care Unit, Paris, France

关键词: Cardiac-arrest;    Acute coronary syndrome;    Glycoprotein IIb;    IIIa inhibitor;    Bleeding;    Stent thrombosis;   

DOI  :  10.1016/j.resuscitation.2020.10.030

来源: Elsevier

【 摘 要 】

Background: Out of hospital cardiac arrest (OHCA) patients requiring percutaneous coronary intervention (PCI) are at higher risk of both stent thrombosis and bleeding. The use of aggressive antiplatelet therapy could lead to a higher risk of bleeding in these patients. Indeed, data on glycoprotein IIb/IIIa inhibitor (GPi) use in this specific indication is scarce. Aim: We sought to evaluate the benefit and safety of GPi use in OHCA patients requiring PCI. Methods and results: Between January 2007 and December 2017, we retrospectively included all consecutive patients treated with PCI for an OHCA from cardiac cause. Clinical, procedural data and in-hospital outcomes were collected. Three hundred and eighty-five patients were included. GPi were administrated in 41.3% of cases (159 patients). Patients who received GPi were younger, had less prior PCI, more often a TIMI 0 or 1 flow before PCI and thromboaspiration use. There were no differences regarding in-hospital definite stent thrombosis among the two groups (11.9% in the GPi group vs 7.1% in the non-GPi group, p = 0.10) or in-hospital mortality (48.6% vs 49.3%, p = 0.68). The incidence of any bleeding (33.3% vs. 19.6%; p = 0.002), and major bleeding (BARC 3-5) (21.9% vs. 16.8%; p = 0.007) was significantly higher in patients receiving GPi. Indeed, using multivariate analysis, GPi use was predictor of major bleeding (OR: 1.81; 95% CI: 1.06-3.08; p = 0.03). Conclusions: In patients treated with PCI for OHCA from cardiac cause, GPi use was associated with an increased risk of major bleeding events, without difference on in-hospital stent thrombosis or death.

【 授权许可】

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