title: Efficacy of pre-hospital use of glycoprotein IIb/IIIa inhibitors in ST-segment elevation myocardial infarction before mechanical reperfusion in a rapid-transfer network (from the Acute Myocardial Infarction Registry of Brittany).
abstract: Previous studies investigating prehospital use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-segment elevation myocardial infarction reached conflicting conclusions. The benefit of this strategy in addition to in-ambulance loading of dual-antiplatelet therapy remains controversial. The aim of this study was to analyze data from a prospective registry of patients with ST-segment elevation myocardial infarctions admitted <24 hours after symptom onset (July 2006 to May 2012). A total of 2,052 patients managed in a physician-staffed mobile intensive care unit (MICU)<12 hours after symptom onset and scheduled for primary percutaneous coronary intervention (PPCI) were retrospectively included. Patients who received GPIs in the MICU were compared with those who did not. The primary end point was infarct-related artery patency, defined as pre-PPCI Thrombolysis In Myocardial Infarction (TIMI) flow grade 3. GPIs were administered in the MICU to 737 patients (36%), including 430<2 hours after symptom onset, and 1,315 patients (64%) did not received prehospital GPIs. Pre-PPCI TIMI flow grade 3 rate was lower in patients treated in the MICU (17.2% vs 21.3%, p=0.03) because of patients treated >2 hours after symptom onset, of whom only 12.7% reached the primary end point. There was no significant difference between groups in the rate of in-hospital major adverse cardiac events. In conclusion, prehospital GPI use in patients with ST-segment elevation myocardial infarctions<12 hours after symptom onset scheduled for PPCI neither improved pre-PPCI infarct-related artery patency nor reduced in-hospital major adverse cardiac events.
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France. Electronic address: vincent.auffret@chu-rennes.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: CHU de Rennes, Service de Pharmacologie Clinique, Rennes, F-35000, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leurent
authors.affiliation: CH de Vannes, Service de Cardiologie, Vannes, F-56000, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Filippi
authors.affiliation: CHU de Rennes, SAMU, Rennes, F-35000, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Coudert
authors.affiliation: CH de Lorient, Service de Cardiologie, Lorient, F-56100, Lorient, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Hacot
authors.affiliation: CHU de Brest, Service de Cardiologie, Brest, F-29200, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.affiliation: CH de Saint Malo, Service de Cardiologie, Saint Malo, F-35400, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rialan
authors.affiliation: CH de Saint Brieuc, Service de Cardiologie, Saint Brieuc, F-22000, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Delaunay
authors.affiliation: CH de Quimper, Service de Cardiologie, Quimper, F-29000, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rouault
authors.affiliation: Clinique Saint Laurent, Service de Cardiologie, Rennes, F-35000, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Druelles
authors.affiliation: CH de Vannes, SAMU, Vannes, F-56000, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Boulanger
authors.affiliation: CHU de Brest, SAMU, Brest, F-29200, France.
authors.forename: Josiane
authors.initials: J
authors.lastname: Treuil
authors.affiliation: CH de Saint Brieuc, SAMU, Saint Brieuc, F-22000, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Avez
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Le Guellec
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000, France; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000552:Ambulances; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D017023:Coronary Angiography; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods; D010045:Outpatients; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012042:Registries; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide