Early upstream GPI use in acute myocardial infarction patients potentially harmful

Early upstream use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with acute myocardial infarction (AMI) should be avoided even in the presence of an intracoronary thrombotic occlusion, as suggested in a study.

The study used data from the Grand Drug-Eluting Stent registry and included 1,329 patients (mean age, 60.4 years; 75.9 percent male) with AMI who had an overt intracoronary thrombus at the initial coronary angiography. Of the patients, 44.7 percent had hypertension, 28.8 percent had diabetes mellitus, and 18.4 percent (n=245) used GPIs.

Compared with nonusers, GPI users had a significantly higher rate of any bleeding events at 30 days (2.9 percent vs 0.9 percent; p=0.015). Multivariable Cox proportional hazards regression analysis confirmed that GPI use was associated with a more than fourfold increase in the risk of 30-day bleeding events (hazard ratio [HR], 4.76, 95 percent confidence interval [CI], 1.66–13.64; p=0.004).

In terms of the efficacy endpoint of a 1-year major adverse cardiovascular event (defined as a composite of all death, myocardial infarction, target lesion revascularization and stent thrombosis), there were no significant differences observed between GPI users and nonusers (9.0 percent vs 7.0 percent, respectively; p=0.287).

Furthermore, GPI use had no significant effect on 1-year major adverse cardiovascular events (HR, 1.33, 95 percent CI, 0.82–2.15; p=0.253).

The present study suggests that even in a population representing patients with a highly thrombotic milieu, GPI use does not reduce adverse clinical outcomes and may even contribute to increased bleeding complications, researchers said. In line with current recommendations, early upstream use of GPIs should not be considered because of the potential harmful effect.