GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists
<b>Objective:</b> To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. <b>Methods</b>: We retrospectivel...
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MDPI AG
2022-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/24/7426 |
| _version_ | 1797457068433604608 |
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| author | Vojko Kanic Gregor Kompara David Suran |
| author_facet | Vojko Kanic Gregor Kompara David Suran |
| author_sort | Vojko Kanic |
| collection | DOAJ |
| description | <b>Objective:</b> To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. <b>Methods</b>: We retrospectively divided 153 patients into two groups (with or without GPI). Thirty-day and one-year all-cause mortality and bleeding were studied. <b>Results</b>: The observed 30-day and one-year all-cause mortality were similar in both groups [54 (69.2%) with GPI vs. 62 (82.7%) without GPI; <i>p</i> = 0.06, and 60 (76.9%) with GPI vs. 64 (85.3%) without GPI; <i>p</i> = 0.22, respectively]. Patients with GPI suffered fewer unsuccessful PCI (TIMI 0/1 was 10% in the GPI group vs. 57% in the group without GPI), experienced more improvements in TIMI ≥ 1 flow [68 (87.2%) in the GPI group vs. 38 (50.7%) without GPI; <i>p</i> < 0.0001], and they achieved better cerebral performance category (CPC) scores (1.61 ± 0.99 with GPI vs. 2.76 ± 1.64 without GPI; <i>p</i> = 0.005). The bleeding rate was similar in patients with and without GPI [33 (42.3%) vs. 31 (41.3%): <i>p</i> = 1.00], in patients with P2Y12 receptor antagonists (P2Y12) [18 (46.1%) with GPI vs. 21 (46.7%) without GPI; <i>p</i> = 1.00], and in patients with potent P2Y12 [8 (30.8%) with GPI vs. 9 (37.5%) without GPI; <i>p</i> = 0.77]. <b>Conclusions</b>: Due to the study design (limited sample size, retrospective inclusion with high risk of selection bias), our analysis does not allow us to draw conclusions about the effectiveness of GPI in this context. Despite all these limitations, GPI were associated with improved TIMI flow after PCI in our multivariable model without increasing bleeding rates. In addition, better CPC scores were observed, but no association between GPI and outcome was found. Our analysis suggests that selective use of GPI may be beneficial in mechanically ventilated patients with MI in CS without additional bleeding risk, even in the era of potent P2Y12. |
| first_indexed | 2024-03-09T16:16:54Z |
| format | Article |
| id | doaj.art-78e3fac745de4f5c99519fb3faf15005 |
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| language | English |
| last_indexed | 2024-03-09T16:16:54Z |
| publishDate | 2022-12-01 |
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| spelling | doaj.art-78e3fac745de4f5c99519fb3faf150052023-11-24T15:45:23ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011124742610.3390/jcm11247426GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor AntagonistsVojko Kanic0Gregor Kompara1David Suran2Department of Cardiology and Angiology, Division of Internal Medicine, University Medical Center Maribor, 2000 Maribor, SloveniaDepartment of Cardiology and Angiology, Division of Internal Medicine, University Medical Center Maribor, 2000 Maribor, SloveniaDepartment of Cardiology and Angiology, Division of Internal Medicine, University Medical Center Maribor, 2000 Maribor, Slovenia<b>Objective:</b> To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. <b>Methods</b>: We retrospectively divided 153 patients into two groups (with or without GPI). Thirty-day and one-year all-cause mortality and bleeding were studied. <b>Results</b>: The observed 30-day and one-year all-cause mortality were similar in both groups [54 (69.2%) with GPI vs. 62 (82.7%) without GPI; <i>p</i> = 0.06, and 60 (76.9%) with GPI vs. 64 (85.3%) without GPI; <i>p</i> = 0.22, respectively]. Patients with GPI suffered fewer unsuccessful PCI (TIMI 0/1 was 10% in the GPI group vs. 57% in the group without GPI), experienced more improvements in TIMI ≥ 1 flow [68 (87.2%) in the GPI group vs. 38 (50.7%) without GPI; <i>p</i> < 0.0001], and they achieved better cerebral performance category (CPC) scores (1.61 ± 0.99 with GPI vs. 2.76 ± 1.64 without GPI; <i>p</i> = 0.005). The bleeding rate was similar in patients with and without GPI [33 (42.3%) vs. 31 (41.3%): <i>p</i> = 1.00], in patients with P2Y12 receptor antagonists (P2Y12) [18 (46.1%) with GPI vs. 21 (46.7%) without GPI; <i>p</i> = 1.00], and in patients with potent P2Y12 [8 (30.8%) with GPI vs. 9 (37.5%) without GPI; <i>p</i> = 0.77]. <b>Conclusions</b>: Due to the study design (limited sample size, retrospective inclusion with high risk of selection bias), our analysis does not allow us to draw conclusions about the effectiveness of GPI in this context. Despite all these limitations, GPI were associated with improved TIMI flow after PCI in our multivariable model without increasing bleeding rates. In addition, better CPC scores were observed, but no association between GPI and outcome was found. Our analysis suggests that selective use of GPI may be beneficial in mechanically ventilated patients with MI in CS without additional bleeding risk, even in the era of potent P2Y12.https://www.mdpi.com/2077-0383/11/24/7426cardiogenic shockGP IIb/IIIa receptor inhibitormechanical ventilationmyocardial infarctionP2Y12 receptor antagonistoutcome |
| spellingShingle | Vojko Kanic Gregor Kompara David Suran GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists Journal of Clinical Medicine cardiogenic shock GP IIb/IIIa receptor inhibitor mechanical ventilation myocardial infarction P2Y12 receptor antagonist outcome |
| title | GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists |
| title_full | GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists |
| title_fullStr | GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists |
| title_full_unstemmed | GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists |
| title_short | GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists |
| title_sort | gp iib iiia receptor inhibitors in mechanically ventilated patients with cardiogenic shock due to myocardial infarction in the era of potent p2y12 receptor antagonists |
| topic | cardiogenic shock GP IIb/IIIa receptor inhibitor mechanical ventilation myocardial infarction P2Y12 receptor antagonist outcome |
| url | https://www.mdpi.com/2077-0383/11/24/7426 |
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