title: Safety and efficacy of adjuvant glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention performed from the radial approach for acute ST segment elevation myocardial infarction.
abstract: The use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) in high-risk patients with acute coronary syndromes has been associated with reductions in ischemic events but increases in bleeding complications. The role of GPIs in patients who undergo primary percutaneous coronary intervention (PCI) by the transradial approach (TRA) is not well studied. The aim of this post hoc analysis from the randomized prospective Acute Myocardial Infarction Treated With Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short- and Long-Term Follow-Up (ATOLL) trial was to assess the safety and efficacy of GPIs in primary PCI performed using the TRA. A total of 910 patients were enrolled in ATOLL; 522 patients (67%) underwent PCI using the TRA. Two comparative analyses were performed. First, patients who underwent PCI using the TRA who received GPIs were compared with those who did not receive GPIs. Second, patients who underwent PCI using the TRA who received GPIs were compared with those who underwent PCI using a nonradial route and received GPIs. Composite end points of net clinical benefit, ischemic outcomes, and safety consisting of bleeding and transfusion at 1 month were analyzed. A propensity score was constructed, and weight adjustment were made for variables, including but not limited to age, weight, gender, renal function, concomitant use of other medications, Killip class, and medical history, when analyzing the end points. There was no significant difference in net clinical benefit or ischemic outcomes between either TRA patients with versus without GPIs or TRA patients with GPIs versus non-TRA patients with GPIs. Additionally, there were significantly fewer major bleeding events and blood transfusions in TRA patients with GPIs compared with non-TRA patients with GPIs. In conclusion, the addition of GPIs in the setting of primary PCI using the TRA was not associated with bleeding liability. The use of GPIs with TRA was associated with safer outcomes than using GPIs with a nontransradial approach. This study was limited in that it was a nonrandomized retrospective analysis.
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA. drzafarzafar@yahoo.com
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.forename: Charles
authors.initials: C
authors.lastname: Pollack
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthelemy
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex