To determine, in a group of patients admitted with ST-elevation myocardial infarction (STEMI), if those treated with Glicoprotein IIb/IIIa inhibitors (GP IIb/IIIa) in the context of primary percutaneous coronary intervention (PCI) differ from patients who were not, regarding epidemiological profile, clinical presentation and prognosis.
A total of 609 consecutive patients with STEMI were evaluated, admitted in a 3-year period (2004–2007) in a single coronary care unit. All patients were submitted to coronary angiography and 518 underwent primary PCI. This later population was divided in two groups: A - treated with GP IIb/IIIa (n = 248) and B –not medicated with GP IIb/IIIa (n = 270).
Group A patients were younger (63 vs. 69 years, p < 0.001), had higher levels of necrosis myocardial markers (troponins, CK-MB mass and CK) (p < 0.001), higher creatinin clearance (76.6 vs. 62.8 mL/min; p < 0.001), higher levels of haemoglobin at admission (14.4 vs. 13.7 g/dL; p < 0.001) and higher BMI (28 vs 27 Kg/m2; p < 0.05). Male gender was more likely to receive GP IIb/IIIa (51% vs. 33%, p < 0.001). Prior history of PCI was significantly more frequent in group A (8.5 vs. 1.6%; p < 0.001). Regarding previous medical therapy, patients medicated with GP IIb/IIIa were more frequently taking statins (35.9 vs. 21.4%; p = 0.008). In relation to therapy in the first 24 hours, group A received significantly more aspirin (98.2 vs.94.9%; p = 0.03) and clopidogrel (92.7 vs 57.9%; p < 0.001). There were no significant differences between the two groups regarding family history, hypertension, diabetes, smoking and previous myocardial infarction, stroke and heart failure. GPIIb/IIIa use was protective regarding in-hospital mortality (7.2 vs. 12.1%; p = 0.044), although no significant difference was found between groups regarding 30-day, 180-day and 1-year mortality (6.5% vs. 8.5%, Log-rank p = 0.180).
In our population, GP IIb/IIIa use in the context of primary PCI shown a protective role regarding in-hospital mortality, which was somewhat lost during follow-up.
GP IIb/IIIa, associated with stenting, are a mainstay in reperfusion strategy in ST-elevation myocardial infarction (STEMI).
Elisabete Jorge, No Financial Disclosure Information; No Product/Research Disclosure Information