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Thromb Haemost 2020; 120(01): 065-074
DOI: 10.1055/s-0039-1700546
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial

Anne H. Tavenier
1   Department of Cardiology, Isala, Zwolle, The Netherlands
,
Renicus S. Hermanides
1   Department of Cardiology, Isala, Zwolle, The Netherlands
,
Enrico Fabris
2   Cardiovascular Department, University of Trieste, Trieste, Italy
,
Frédéric Lapostolle
3   SAMU 93, Hôspital Avícenne, Bobigny, France
,
Johanne Silvain
4   ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
,
Jurrien M. ten Berg
5   Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Jens F. Lassen
6   Department of Cardiology, Odense University Hospital, Odense, Denmark
,
Leonardo Bolognese
7   Cardiovascular Department, Azienda Ospedaliera, Toscana Sudest, Arezzo, Italy
,
Warren J. Cantor
8   Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Canada
,
Ángel Cequier
9   Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain
,
Mohamed Chettibi
10   Centre Hospitalo Universitaire Frantz Fanon, Blida, Algeria
,
Shaun G. Goodman
11   Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Canada
,
Christopher J. Hammett
12   Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
,
Kurt Huber
13   3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital , Medical School, Sigmund Freud University, Vienna, Austria
,
Magnus Janzon
14   Department of Cardiology, Linköping University, Linköping, Sweden
15   Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
,
Béla Merkely
16   Heart and Vascular Center, Semmelweis University, Budapest, Hungary
,
Robert F. Storey
17   Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
,
Uwe Zeymer
18   Klinikum Ludwigshafen und Institut für Herzinfarktforschung, Ludwigshafen, Germany
,
Patrick Ecollan
4   ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
,
Jean-Phillipe Collet
4   ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
,
Frank F. Willems
19   Rijnstate Hospital, Arnhem, The Netherlands
,
Abdourahmane Diallo
20   ACTION Study Group, Statistical Unit, Lariboisière Hospital (AP-HP), Paris VII University, Paris, France
,
Eric Vicaut
20   ACTION Study Group, Statistical Unit, Lariboisière Hospital (AP-HP), Paris VII University, Paris, France
,
Christian W. Hamm
21   Kerckhoff Campus, University of Giessen, Bad Nauheim, Germany
,
Gilles Montalescot
4   ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
,
Arnoud W. J. van 't Hof
1   Department of Cardiology, Isala, Zwolle, The Netherlands
22   Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
23   Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
,
ATLANTIC investigators › Author Affiliations
Further Information

Publication History

05 June 2019

07 September 2019

Publication Date:
21 November 2019 (online)

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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

glycoprotein IIb/IIIa inhibitors - primary percutaneous coronary intervention - STEMI - ticagrelor - bailout - tirofiban - eptifibatide - abciximab

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