title: ADP receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a post hoc IABP-SHOCK II trial subgroup analysis.
abstract: OBJECTIVE
  The aim of this post hoc subgroup analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II trial was to compare the clinical outcome of patients treated with either clopidogrel or the newer, more potent P2Y12 receptor inhibitors prasugrel or ticagrelor.
  
  
  RESULTS
  The primary endpoint was one-year mortality with respect to different P2Y12 receptor inhibitors. Secondary safety endpoints were GUSTO bleedings until hospital discharge. After exclusion of 117 patients (patients who died before or during PCI, patients with unavailable information on P2Y12 receptor inhibitor treatment, patients not receiving or receiving a combination of different P2Y12 receptor inhibitors as acute antiplatelet therapy), 483 patients were analysed. Of these, 373 patients (77.2%) received clopidogrel and 110 patients (22.8%) either prasugrel or ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality did not differ between prasugrel/ticagrelor and clopidogrel treated patients (HR: 0.83, 95% CI: 0.59-1.19, padj=0.31). GUSTO bleedings did not differ between groups (14.3% for prasugrel/ticagrelor and 16.4% for clopidogrel, HR: 0.91, 95% CI: 0.55-1.5, padj=0.7).
  
  
  CONCLUSIONS
  This IABP-SHOCK II trial subgroup analysis shows that the use of potent P2Y12 receptor inhibitors like prasugrel or ticagrelor is feasible and might not be harmful in selected patients with cardiogenic shock complicating acute myocardial infarction. However, the superiority in comparison to clopidogrel remains to be proven.
authors.affiliation: Ludwig-Maximilians-Universität, Munich and German Heart Center Munich, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Orban
authors.forename: Tobias
authors.initials: T
authors.lastname: Limbourg
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Ferenc
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Olbrich
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Marcus
authors.initials: M
authors.lastname: Hennersdorf
authors.forename: Klaus
authors.initials: K
authors.lastname: Empen
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D013876:Thiophenes / Q000008:administration & dosage / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D013988:Ticlopidine