@article{f75a532c5e1445f3bf681ba7d7135e61,
title = "Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial",
abstract = "Background Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not been fully investigated. Methods 1,630 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients were divided in three groups: no GPI, GPI administration routinely before primary PCI, and GPI administration in bailout situations. The primary efficacy outcome was a composite of death, myocardial infarction, urgent target revascularization, and definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass graft (CABG)-related PLATO major bleeding at 30 days. Results Compared with no GPI ( n = 930), routine GPI ( n = 525) or bailout GPI ( n = 175) was not associated with an improved primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p = 0.58). After multivariate analysis, the use of GPI in bailout situations was associated with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.32-6.64; p = 0.03). However, routine GPI use compared with no GPI was not associated with a significant increase in bleeding (OR 1.78, 95% CI 0.88-3.61; p = 0.92). Conclusion Use of GPIs in addition to ticagrelor in STEMI patients was not associated with an improvement in 30-day ischemic outcome. A significant increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who received GPIs in a bailout situation.",
keywords = "abciximab, acute myocardial-infarction, bailout, eptifibatide, glycoprotein iib, high-dose tirofiban, iib-iiia inhibitors, iiia inhibitors, individual patients data, percutaneous coronary intervention, platelet inhibition, prehospital initiation, primary angioplasty, primary percutaneous coronary intervention, st-segment elevation, stemi, stent thrombosis, ticagrelor, tirofiban, IIIa inhibitors, HIGH-DOSE TIROFIBAN, STEMI, ACUTE MYOCARDIAL-INFARCTION, glycoprotein IIb, PRIMARY ANGIOPLASTY, STENT THROMBOSIS, IIB-IIIA INHIBITORS, INDIVIDUAL PATIENTS DATA, PERCUTANEOUS CORONARY INTERVENTION, PREHOSPITAL INITIATION, PLATELET INHIBITION, ST-SEGMENT ELEVATION",
author = "A.H. Tavenier and R.S. Hermanides and E. Fabris and F. Lapostolle and J. Silvain and {ten Berg}, J.M. and J.F. Lassen and L. Bolognese and W.J. Cantor and A. Cequier and M. Chettibi and S.G. Goodman and C.J. Hammett and K. Huber and M. Janzon and B. Merkely and R.F. Storey and U. Zeymer and P. Ecollan and J.P. Collet and F.F. Willems and A. Diallo and E. Vicaut and C. Hamm and G. Montalescot and {van 't Hof}, A.W.J. and {ATLANTIC Investigators}",
note = "Funding Information: A.W.J.v.{\textquoteleft}t H. reports institutional fees and nonfinancial support from AstraZeneca and grants from Medtronic. C. W.H. reports institutional fees and personal fees from AstraZeneca. R.F.S. reports institutional research grants from AstraZeneca and PlaqueTec; consultancy fees from AstraZeneca, Avacta, Bayer, Bristol Myers Squibb/Pfizer, Haemonetics, Idorsia, Novartis, PlaqueTec, and Thrombo-serin; and honoraria from AstraZeneca and Bayer. J.F.L. reports unrestricted grants from Medtronic, Abbott, Boston Scientific, Biotronik, and Terumo. A.C. reports institutional research grants from Abbott Vascular, Boston Scientific, Cordis, Medtronic, and Orbus Neich, and consulting/lecture fees from Abbott Vascular, AstraZe-neca, Biotronik, Ferrer International, Medtronic, and Terumo. U.Z. reports grants and personal fees from Astra-Zeneca during the conduct of the study, personal fees from Bayer, grants and personal fees from BMS, grants and personal fees from Daiichi Sankyo, personal fees from Boehringer Ingelheim, personal fees from Medicines Company, personal fees from Sanofi, grants and personal fees from Novartis, outside the submitted work. M.J. reports lecture fees from AstraZeneca and Pfizer. K.H. reports lecture fees from AstraZeneca, Bayer, Boehringer Ingel-heim, Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aven-tis, and the Medicines Company. J.S. reports the following disclosures during the past two years: Consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, CSL Behring, Gilead Science, and Sanofi-Aventis; Speaker honorariums from AstraZeneca, Amgen, Bayer, Algorythm, and Sanofi-Aventis; and travel supports form Amgen, Astra-Zeneca, Bayer, and Bristol-Myer Squibb. S.G.G. has received research grant support and/or speaker/consulting honoraria from AstraZeneca, Bayer Bristol Myers Squibb, Daiichi-Sankyo, Eli Lilly, Fenix Group Internation, and Sanofi. L.B. reports lecture fees from AstraZeneca, Bayer, Amgen, Daiichi Sankyo, and Sanofi Aventis. Publisher Copyright: {\textcopyright} 2020 American Institute of Physics Inc.. All rights reserved.",
year = "2020",
month = jan,
day = "1",
doi = "10.1055/s-0039-1700546",
language = "English",
volume = "120",
pages = "65--74",
journal = "Thrombosis and Haemostasis",
issn = "0340-6245",
publisher = "Georg Thieme Verlag",
number = "1",
}