title: GPIIb-IIIa Receptor Inhibitors in Acute Coronary Syndrome Patients Presenting With Cardiogenic Shock and/or After Cardiopulmonary Resuscitation.
abstract: BACKGROUND
  Data on the use of GPIIb-IIIa receptor inhibitors (GPI) in acute coronary syndrome (ACS) patients presenting with cardiogenic shock and/or after cardiopulmonary resuscitation is sparse. The aim of the study was to establish the possible influence of the adjunctive use of GPI on 30-day and 1-year mortality in these high-risk patients.
  
  
  METHODS
  Acute coronary syndrome patients (261), who presented with cardiogenic shock and/or were cardiopulmonary resuscitated on admission, were analysed. Groups receiving (170 patients) and not receiving (91 patients) GPI were compared regarding 30-day and 1-year mortality.
  
  
  RESULTS
  The unadjusted all-cause 30-day and 1-year mortality were similar in patients receiving GPI and those not receiving GPI [79 patients (46.5%) vs 50 patients (54.9%) at 30 days; ns, 91 patients (53.5%) vs. 55 (61.1%) at 1 year; ns]. After the adjustment for baseline and clinical characteristics, the adjunctive usage of GPI was identified as an independent prognostic factor in lower 30-day mortality (adjusted OR: 0.41; 95%CI: 0.20 to 0.84; p=0.015) and 1-year mortality (HR 0.62; 95%CI 0.39-0.97; p=0.037). Age, left main PCI and major bleeding,were also identified as independent prognostic factors in worse 30-day and 1-year mortality. In addition, Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 pre-percutaneous coronary intervention (PCI) predicted a worse 1-year outcome. Novel oral P2Y12 receptor antagonists predicted better 30-day and 1-year survival.
  
  
  CONCLUSIONS
  Our study suggests that the adjunctive usage of GPI may be beneficial in this high-risk group of patients in whom a delayed onset of action of oral antiplatelet therapy would be expected.
authors.affiliation: University Medical Centre Maribor, Maribor, Slovenia. Electronic address: vojko.kanic@guest.arnes.si.
authors.forename: Vojko
authors.initials: V
authors.lastname: Kanic
authors.affiliation: Herzzentrum Leipzig, Leipzig, Germany.
authors.forename: Maja
authors.initials: M
authors.lastname: Vollrath
authors.affiliation: University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Meta
authors.initials: M
authors.lastname: Penko
authors.affiliation: University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Andrej
authors.initials: A
authors.lastname: Markota
authors.affiliation: University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Kompara
authors.affiliation: University Medical Centre Maribor, Maribor, Slovenia.
authors.forename: Zlatka
authors.initials: Z
authors.lastname: Kanic
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002423:Cause of Death / Q000639:trends; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Acute coronary syndrome; Cardiogenic shock; Cardiopulmonary resuscitation; GPIIb-IIIa receptor inhibitors; P2Y12 receptor antagonists