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

糖蛋白 IIb/IIIa 抑制剂对替格瑞洛治疗 STEMI 的疗效和安全性: ATLANTIC 试验的子分析。

  • 影响因子:3.90
  • DOI:10.1055/s-0039-1700546
  • 作者列表:"Tavenier AH","Hermanides RS","Fabris E","Lapostolle F","Silvain J","Ten Berg JM","Lassen JF","Bolognese L","Cantor WJ","Cequier Á","Chettibi M","Goodman SG","Hammett CJ","Huber K","Janzon M","Merkely B","Storey RF","Zeymer U","Ecollan P","Collet JP","Willems FF","Diallo A","Vicaut E","Hamm CW","Montalescot G","van 't Hof AWJ","ATLANTIC investigators.
  • 发表时间:2020-01-01
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.

摘要

背景: 糖蛋白 IIb/IIIa 抑制剂 (gp is) 联合氯吡格雷可改善 ST 段抬高型心肌梗死 (STEMI) 的临床预后; 然而, 找到一个平衡,最大限度地减少血栓形成和出血的风险仍然是根本。除了替格瑞洛 (一种更有效的 P2Y12-inhibitor) 之外,GPI 的疗效和安全性尚未得到充分研究。 方法: 在大西洋试验的子分析中分析了 1,630 例接受直接经皮冠状动脉介入治疗 (PCI) 的 STEMI 患者。将患者分为三组: 无 GPI,直接 PCI 前常规给予 GPI,救助情况下给予 GPI。主要疗效结局为 30 天时死亡、心肌梗死、紧急目标血运重建和明确的支架内血栓形成。安全性结果是 30 天的非冠状动脉旁路移植术 (CABG) 相关 PLATO 大出血。 结果: 与无 GPI (n = 930) 、常规 GPI (n = 525) 或救助 GPI (n = 175) 相比与改善的主要疗效结局无关 (4.2% 无 GPI vs. 4.0% 常规 GPI vs. 6.9% 救助 GPI; p = 0.58)。经过多变量分析,与无 GPI 相比,在救助情况下使用 GPI 与非 CABG 相关出血的发生率较高 (比值比 [OR] 2.96, 95% 置信区间 [CI] 1.32-6.64; p = 0.03)。然而,与无 GPI 相比,常规使用 GPI 与出血显著增加无关 (OR 1.78,95% CI 0.88-3.61; p = 0.92)。 结论: STEMI 患者除使用替格瑞洛外使用 gp 与 30 天缺血结局的改善无关。在救助情况下接受 gp 的患者中,30 天非 CABG 相关柏拉图大出血显著增加。

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影响因子:3.90
发表时间:2020-01-01
DOI:10.1055/s-0039-1700546
作者列表:["Tavenier AH","Hermanides RS","Fabris E","Lapostolle F","Silvain J","Ten Berg JM","Lassen JF","Bolognese L","Cantor WJ","Cequier Á","Chettibi M","Goodman SG","Hammett CJ","Huber K","Janzon M","Merkely B","Storey RF","Zeymer U","Ecollan P","Collet JP","Willems FF","Diallo A","Vicaut E","Hamm CW","Montalescot G","van 't Hof AWJ","ATLANTIC investigators."]

METHODS: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.

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影响因子:1.21
发表时间:2020-01-01
DOI:10.1097/MCA.0000000000000737
作者列表:["Huang X","Chen S","Redfors B","Zhang Y","Souza CF","Mehran R","Bansilal S","Kirtane AJ","Brener SJ","Feite F","Dangas GD","Ben-Yehuda O","Stone GW"]

METHODS:OBJECTIVES:There are limited data on bivalirudin monotherapy in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) with positive biomarkers of myocardial necrosis (troponin and/or creatine kinase-myocardial band isoenzyme). We sought to evaluate the safety and efficacy of bivalirudin monotherapy in patients with positive biomarkers from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. PATIENTS AND METHODS:We compared the net adverse clinical events [composite ischemia - (death, myocardial infarction, or unplanned ischemic revascularization) - or noncoronary artery bypass graft surgery (CABG)-related major bleeding] among patients with biomarker-positive NSTE-ACS in the ACUITY trial overall and by antithrombotic strategy. RESULTS:Among 13 819 patients with NSTE-ACS enrolled in ACUITY, 4728 patients presented with positive biomarkers and underwent an early invasive strategy. Of those, 1547 were randomized to heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), 1555 to bivalirudin plus GPI, and 1626 to bivalirudin monotherapy. Compared with biomarker-negative patients, biomarker-positive patients had higher 30-day rates of net adverse clinical events (14.0 vs. 12.4%; P = 0.04), all-cause death (1.3 vs. 0.5%; P = 0.001), cardiac death (1.1 vs. 0.5%; P = 0.005), and non-CABG-related major bleeding (6.5 vs. 5.2%, P = 0.03). At 30 days, bivalirudin monotherapy was associated with significantly less non-CABG-related major bleeding (bivalirudin monotherapy 4.1% vs. bivalirudin plus GPI 8.4% vs. heparin plus GPI 7.1%) with comparable rates of composite ischemia (bivalirudin monotherapy 9.2% vs. bivalirudin plus GPI 9.9% vs. heparin plus GPI 8.4%). In a multivariable model, bivalirudin monotherapy was associated with a significant reduction in non-CABG-related major bleeding but was not associated with an increased risk of death, myocardial infarction, unplanned revascularization or stent thrombosis. CONCLUSION:Compared with heparin plus GPI or bivalirudin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding at 30 days among patients with NSTE-ACS and positive biomarkers.

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翻译标题与摘要 下载文献
影响因子:2.86
发表时间:2020-01-01
DOI:10.1016/j.amjcard.2019.09.045
作者列表:["Ravi V","Pulipati P","Vij A","Kodumuri V"]

METHODS:Atrial fibrillation (AF) and concomitant coronary artery disease (CAD) create a therapeutic dilemma as the risk of bleeding with triple antithrombotic therapy (TATT) must be balanced against the risk of ischemic events with double antithrombotic therapy (DATT). The aim of this meta-analysis is to compare the efficacy and safety of DATT versus TATT in AF and CAD. MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched for relevant articles published from inception to May 1, 2019. Studies comparing the safety and efficacy of DATT versus TATT in patients with AF and CAD were included. Among 9 studies, where 6,104 patients received DATT and 7,333 patients received TATT, there was no statistically significant difference in the outcomes of mortality, nonfatal myocardial infarction, stent thrombosis, and stroke. There was a lower rate of major bleeding in DATT (risk ratio [RR] 0.64 [95% confidence interval [CI] 0.54 to 0.75]; p <0.001). There was no significant difference in stent thrombosis (RR 1.52 [95% CI 0.97 to 2.38]; p = 0.07). However, subgroup analysis of trials with direct oral anticoagulant use demonstrated a borderline higher rate of stent thrombosis in DATT (RR 1.66 [95% CI 1.01 to 2.73]; p = 0.05). In conclusion, DATT showed no difference in the outcomes of mortality, stroke, nonfatal myocardial infarction, and stent thrombosis compared with TATT. DATT demonstrated a lower rate of major bleeding. DATT demonstrated a borderline higher rate of stent thrombosis in the subgroup analysis of trials with direct oral anticoagulant which needs to be evaluated in further studies.

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