Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study.

Bruno, Francesco; Wenzl, Florian A; De Filippo, Ovidio; Kraler, Simon; Giacobbe, Federico; Roffi, Marco; Muller, Olivier; Räber, Lorenz; Templin, Christian; Maria De Ferrari, Gaetano; D'Ascenzo, Fabrizio; Lüscher, Thomas F (2024). Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study. European heart journal. Cardiovascular pharmacotherapy, 10(5), pp. 391-402. Oxford University Press 10.1093/ehjcvp/pvae024

[img] Text
pvae024.pdf - Accepted Version
Restricted to registered users only until 12 April 2025.
Available under License Publisher holds Copyright.

Download (3MB)

AIMS

Data on Glycoprotein IIb/IIIa inhibitors (GPI) use in real world ACS patients following the introduction of potent P2Y12 inhibitors and newer generation stents are scant. Here, we aimed to assess the utilization, effectiveness, and safety of GPI in a large prospective multi-centre cohort of contemporary ACS patients.

METHODS AND RESULTS

SPUM-ACS prospectively recruited patients presenting with ACS between 2009 and 2017. The primary endpoint of the present study was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction (MI) and non-fatal stroke at one year. Secondary endpoints were defined as any bleeding events, BARC 3-5 bleeding, and net adverse cardiovascular events (NACE). A total of 4395 ACS patients were included in the analysis. GPI-treated patients had more total coronary artery occlusion (56% vs 35%, p<0.001) and thrombus (60% vs 35%, p<0.001) at angiography. Among the propensity score matched (PSM) population (1992 patients equally split into two groups), GPI-treated patients showed lower risk of MACE (PSM adjusted HR 0.70, 95% CI 0.49-0.99), but a higher risk of any (PSM adj HR 1.46, 95% CI 1.06-1.99) and major bleedings (PSM adj HR 1.73, 95% CI 1.09-2.76), resulting in a neutral effect on NACE (PSM adj HR 0.87, 95% CI 0.65-1.17). These results remained consistent across all subgroups.

CONCLUSION

In patients with ACS undergoing PCI and receiving potent P2Y12 inhibitors, we observed a reduced risk of MACE and an increased risk of major bleedings at 1 year in patients treated with GPI. Although the routine use of GPI is currently not recommended, they might be considered in selected patients following a personalized balancing between ischaemic and bleeding risks.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Räber, Lorenz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2055-6845

Publisher:

Oxford University Press

Language:

English

Submitter:

Pubmed Import

Date Deposited:

12 Apr 2024 14:42

Last Modified:

16 Aug 2024 00:12

Publisher DOI:

10.1093/ehjcvp/pvae024

PubMed ID:

38604747

Uncontrolled Keywords:

Bleeding acute coronary syndrome coronary intervention glycoprotein IIb/IIIa

BORIS DOI:

10.48350/195908

URI:

https://boris.unibe.ch/id/eprint/195908

Actions (login required)

Edit item Edit item
Provide Feedback