Abstract 3007: Glycoprotein IIb/IIIa Inhibitors before Primary Percutaneous Coronary Intervention of ST-Elevation Myocardial Infarction Improve Perfusion and Outcomes: Insights from APEX-AMI
Background: APEX-AMI provides a unique contemporary opportunity to explore the influence of glycoprotein IIb/IIIa inhibitors (GPIs) and their timing on myocardial perfusion and outcomes in STEMI pts undergoing primary PCI.
Methods: APEX-AMI tested pexelizumab in 5745 STEMI pts undergoing primary PCI; no treatment effect occurred. Perfusion (TIMI Flow and 30-min post-PCI ST-resolution) and endpoints (90-d death, in-hospital severe bleeding) were compared across early GPI (i.e., pre-cath), subsequent administration (i.e., late/post-cath) and non-users.
Results: Of 5745 pts, 3988 (69.4%) received GPIs: in 1125 (28.3%), GPIs were administered pre-cath (median 37 (IQR: 16 – 66) min): cath occurred 181min (median, IQR: 133–253) after symptom onset. Abciximab was used most often (64.6%, eptifibatide: 28.7%, tirofiban: 6.6%). Although TIMI Flow Grade 2/3 was lowest in GPI users in the culprit artery at first angiogram (Table⇓) impaired flow was highest among non-users after PCI. Furthermore complete ST-resolution (i.e.≥70%) occurred more frequently and 90 mortality was lowest amongst those receiving GPI early (Table & figure⇓). Severe bleeding was not related to GPI use (Table⇓).
Conclusion: Our findings highlight the benefits of GPI on both epicardial and myocardial perfusion and 90-day mortality in STEMI, especially when administered early in pts undergoing primary PCI. Notably, inhospital bleeding was not increased after GPI use.