TY - JOUR
T1 - Efficacy and safety of glycoprotein IIb/IIIa inhibitors in addition to P2Y(12) inhibitors in ST-segment elevation myocardial infarction
T2 - A subanalysis of the POPular Genetics trial
AU - Tavenier, Anne H.
AU - Claassens, Daniel M. F.
AU - Hermanides, Renicus S.
AU - Vos, Gerrit J. A.
AU - Bergmeijer, Thomas O.
AU - Kelder, Johannes C.
AU - Deneer, Vera H. M.
AU - Hof, Arnoud W. J. van 't
AU - Ten Berg, Jurrien M.
N1 - Funding Information:
The authors thank Pim van der Harst, MD, PhD, Emanuele Barbato, MD, PhD, Carmine Morisco, MD, PhD, Melvyn Tjon Joe Gin, MD, Folkert Asselbergs, MD, PhD, Arend Mosterd, MD, PhD, Jean‐Paul Herrman, MD, PhD, and Willem Dewilde, MD, PhD, for their efforts in conducting this trial. The POPular Genetics trial was conducted with a government grant from The Netherlands Organisation for Health Research and Development (project number 171102022). Spartan Bioscience Inc. (Ottawa, Canada) provided the point‐of‐care system and testing reagents used for free.
Funding Information:
Dr Arnoud W. J. van 't Hof reports grants from Medtronic and Sanofi, grants and personal fees from Astra Zeneca, and personal fees from AMGEN, outside the submitted work. Dr Daniel M. F. Claassens, Dr Gerrit J. A. Vos, Dr Thomas O. Bergmeijer, Dr Vera H. M. Deneer, and Dr Johannes C. Kelder report a grant from ZonMW and nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Renicus S. Hermanides reports nonfinancial support from Spartan during the conduct of the POPular Genetics trial. Dr Jurriën M. ten Berg reports grants and personal fees from AstraZeneca and personal fees from Daiichi Sankyo, Eli Lilly, Medicines Company, Accumetrics, Boehringer‐Ingelheim, Bayer, BMS, Pfizer, and Ferrer, outside the submitted work. All other authors report no potential conflict of interest.
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2022/2
Y1 - 2022/2
N2 - Background Glycoprotein IIb/IIIa inhibitors (GPI) are still used in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), although discussion about its clinical benefit is ongoing. Methods GPI use was analyzed in this subanalysis of the POPular Genetics trial, which randomized STEMI patients to CYP2C19 genotype-guided treatment (clopidogrel or ticagrelor) or standard treatment with ticagrelor/prasugrel. The composite thrombotic endpoint consisted of cardiovascular death, myocardial infarction (MI), definite stent thrombosis, and stroke at 30 days. The combined bleeding endpoint consisted of Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding at 30 days. Univariable and multivariable analyses in addition to a propensity score-matched (PSM) analysis were conducted. Results In total, 2378 patients, of whom 1033 received GPI and 1345 did not, were included. In multivariable analysis, GPI administration was associated with fewer thrombotic events (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.09-0.55) and MIs (HR 0.24, 95% CI 0.08-0.73). Furthermore, GPI administration was associated with an increase in bleedings (HR 2.02, 95% CI 1.27-3.19), driven by minor bleedings (HR 2.32, 95% CI 1.43-3.76), without a significant difference in major bleedings (HR 0.69, 95% CI 0.19-2.57). In the PSM analysis, no significant association was found. Conclusion In STEMI patients undergoing primary PCI, GPI administration was associated with a reduction in thrombotic events at a cost of an increase in (mostly minor) bleedings in multivariable analysis, while propensity score analysis did not show significant associations.
AB - Background Glycoprotein IIb/IIIa inhibitors (GPI) are still used in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), although discussion about its clinical benefit is ongoing. Methods GPI use was analyzed in this subanalysis of the POPular Genetics trial, which randomized STEMI patients to CYP2C19 genotype-guided treatment (clopidogrel or ticagrelor) or standard treatment with ticagrelor/prasugrel. The composite thrombotic endpoint consisted of cardiovascular death, myocardial infarction (MI), definite stent thrombosis, and stroke at 30 days. The combined bleeding endpoint consisted of Platelet Inhibition and Patient Outcomes (PLATO) major and minor bleeding at 30 days. Univariable and multivariable analyses in addition to a propensity score-matched (PSM) analysis were conducted. Results In total, 2378 patients, of whom 1033 received GPI and 1345 did not, were included. In multivariable analysis, GPI administration was associated with fewer thrombotic events (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.09-0.55) and MIs (HR 0.24, 95% CI 0.08-0.73). Furthermore, GPI administration was associated with an increase in bleedings (HR 2.02, 95% CI 1.27-3.19), driven by minor bleedings (HR 2.32, 95% CI 1.43-3.76), without a significant difference in major bleedings (HR 0.69, 95% CI 0.19-2.57). In the PSM analysis, no significant association was found. Conclusion In STEMI patients undergoing primary PCI, GPI administration was associated with a reduction in thrombotic events at a cost of an increase in (mostly minor) bleedings in multivariable analysis, while propensity score analysis did not show significant associations.
KW - clopidogrel
KW - glycoprotein IIb
KW - IIIa inhibitors
KW - primary percutaneous coronary intervention
KW - STEMI
KW - ticagrelor
KW - PERCUTANEOUS CORONARY INTERVENTION
KW - INDIVIDUAL PATIENTS DATA
KW - IIB-IIIA INHIBITORS
KW - HIGH-DOSE TIROFIBAN
KW - PRIMARY ANGIOPLASTY
KW - PREHOSPITAL INITIATION
KW - STENT THROMBOSIS
KW - FEMORAL ACCESS
KW - TASK-FORCE
KW - LONG
U2 - 10.1002/ccd.29861
DO - 10.1002/ccd.29861
M3 - Article
C2 - 34233065
SN - 1522-1946
VL - 99
SP - 676
EP - 685
JO - Catheterization and Cardiovascular interventions
JF - Catheterization and Cardiovascular interventions
IS - 3
ER -