Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: insights from the APEX-AMI trial
Identifieur interne : 007052 ( Main/Exploration ); précédent : 007051; suivant : 007053Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: insights from the APEX-AMI trial
Auteurs : Kurt Huber [Autriche] ; David R. Holmes [États-Unis] ; Arnoud W. Van T Hof [Pays-Bas] ; Gilles Montalescot [France] ; Philip E. Aylward [Australie] ; G. Amadeo Betriu [Espagne] ; Petr Widimsky [République tchèque] ; Cynthia M. Westerhout [Canada] ; Christopher B. Granger [États-Unis] ; Paul W. Armstrong [Canada]Source :
- European Heart Journal [ 0195-668X ] ; 2010-07.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Aims Controversy exists regarding the early use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial provides a unique opportunity to examine early vs. late or non-use of GPIs in a large STEMI cohort treated with PCI. Methods and results In the APEX-AMI trial, 3969 of 5707 patients received one of three GPIs at the operator's discretion (abciximab, eptifibatide, tirofiban). Of GPI-treated patients, the median time from symptom onset to GPI administration was 180 min (25th, 75th percentile: 130, 258); 1125 received the agent prior to arriving in the catheterization laboratory [pre-sheath; GPI to sheath insertion: 37 min (16, 66)], whereas 2844 patients were treated after arrival in the catheterization laboratory [in-lab; sheath insertion to GPI: 16 min (10, 27)]. The pre-sheath use of GPIs was associated with a significantly lower hazard of 90-day mortality [adjusted hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.48–0.95, P = 0.025] and of 90-day composite of death/CHF/shock (adjusted HR 0.81, 95% CI 0.65–1.00, P = 0.054). In-hospital severe and moderate bleeding was not related to the use of GPIs. Conclusion This retrospective analysis from a large patient cohort with acute STEMI undergoing PCI suggests that pharmacological pre-treatment of PCI with GPIs, particularly abciximab, was associated with significantly lower occurrence of 90-day clinical outcomes and supports the pre-procedural administration of GPIs in this clinical setting. Clinical trial registration information: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637.
Url:
DOI: 10.1093/eurheartj/ehq143
Affiliations:
- Australie, Autriche, Canada, Espagne, France, Pays-Bas, République tchèque, États-Unis
- Bohême centrale, Caroline du Nord, Catalogne, Minnesota, Vienne (Autriche), Île-de-France
- Barcelone, Paris, Prague, Vienne (Autriche)
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Van T Hof</name><affiliation wicri:level="1"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Division of Cardiology, Hospital ‘De Weezenlanden’, Zwolle</wicri:regionArea><wicri:noRegion>Zwolle</wicri:noRegion></affiliation></author><author><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Centre Hospitalier Universitaire Pite-Salpetriere, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Aylward, Philip E" sort="Aylward, Philip E" uniqKey="Aylward P" first="Philip E." last="Aylward">Philip E. 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Westerhout</name><affiliation wicri:level="1"><country>Canada</country><wicri:regionArea>Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, 2-51 Medical Sciences Building, Edmonton, AB</wicri:regionArea><wicri:noRegion>AB</wicri:noRegion></affiliation></author><author><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Duke Clinical Research Institute, Durham, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Armstrong, Paul W" sort="Armstrong, Paul W" uniqKey="Armstrong P" first="Paul W." last="Armstrong">Paul W. Armstrong</name><affiliation wicri:level="1"><country>Canada</country><wicri:regionArea>Division of Cardiology, Canadian VIGOUR Centre, University of Alberta, 2-51 Medical Sciences Building, Edmonton, AB</wicri:regionArea><wicri:noRegion>AB</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Canada</country></affiliation><affiliation><wicri:noCountry code="syntax">???</wicri:noCountry></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Canada</country></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-07">2010-07</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">14</biblScope><biblScope unit="page" from="1708">1708</biblScope><biblScope unit="page" to="1716">1716</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Angioplasty</term><term>Apex</term><term>Atherectomy</term><term>Cardiology</term><term>Circulatory system</term><term>Coronary artery</term><term>Coronary heart disease</term><term>Fibrinolytic</term><term>Glycoprotein IIIa</term><term>Instrumental dilatation</term><term>Instrumentation therapy</term><term>Myocardial infarction</term><term>Percutaneous route</term><term>Primary</term><term>ST elevation</term><term>Stent</term><term>Use</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Angioplastie</term><term>Apex</term><term>Appareil circulatoire</term><term>Artère coronaire</term><term>Athérectomie</term><term>Cardiologie</term><term>Cardiopathie coronaire</term><term>Dilatation instrumentale</term><term>Fibrinolytique</term><term>Glycoprotéine IIIa</term><term>Infarctus du myocarde</term><term>Primaire</term><term>Stent</term><term>Susdécalage ST</term><term>Traitement instrumental</term><term>Utilisation</term><term>Voie percutanée</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">Aims Controversy exists regarding the early use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial provides a unique opportunity to examine early vs. late or non-use of GPIs in a large STEMI cohort treated with PCI. Methods and results In the APEX-AMI trial, 3969 of 5707 patients received one of three GPIs at the operator's discretion (abciximab, eptifibatide, tirofiban). Of GPI-treated patients, the median time from symptom onset to GPI administration was 180 min (25th, 75th percentile: 130, 258); 1125 received the agent prior to arriving in the catheterization laboratory [pre-sheath; GPI to sheath insertion: 37 min (16, 66)], whereas 2844 patients were treated after arrival in the catheterization laboratory [in-lab; sheath insertion to GPI: 16 min (10, 27)]. The pre-sheath use of GPIs was associated with a significantly lower hazard of 90-day mortality [adjusted hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.48–0.95, P = 0.025] and of 90-day composite of death/CHF/shock (adjusted HR 0.81, 95% CI 0.65–1.00, P = 0.054). In-hospital severe and moderate bleeding was not related to the use of GPIs. Conclusion This retrospective analysis from a large patient cohort with acute STEMI undergoing PCI suggests that pharmacological pre-treatment of PCI with GPIs, particularly abciximab, was associated with significantly lower occurrence of 90-day clinical outcomes and supports the pre-procedural administration of GPIs in this clinical setting. Clinical trial registration information: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Autriche</li><li>Canada</li><li>Espagne</li><li>France</li><li>Pays-Bas</li><li>République tchèque</li><li>États-Unis</li></country><region><li>Bohême centrale</li><li>Caroline du Nord</li><li>Catalogne</li><li>Minnesota</li><li>Vienne (Autriche)</li><li>Île-de-France</li></region><settlement><li>Barcelone</li><li>Paris</li><li>Prague</li><li>Vienne (Autriche)</li></settlement></list><tree><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Huber, Kurt" sort="Huber, Kurt" uniqKey="Huber K" first="Kurt" last="Huber">Kurt Huber</name></region></country><country name="États-Unis"><region name="Minnesota"><name sortKey="Holmes, David R" sort="Holmes, David R" uniqKey="Holmes D" first="David R." last="Holmes">David R. Holmes</name></region><name sortKey="Granger, Christopher B" sort="Granger, Christopher B" uniqKey="Granger C" first="Christopher B." last="Granger">Christopher B. Granger</name></country><country name="Pays-Bas"><noRegion><name sortKey="Van T Hof, Arnoud W" sort="Van T Hof, Arnoud W" uniqKey="Van T Hof A" first="Arnoud W." last="Van T Hof">Arnoud W. Van T Hof</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name></region></country><country name="Australie"><noRegion><name sortKey="Aylward, Philip E" sort="Aylward, Philip E" uniqKey="Aylward P" first="Philip E." last="Aylward">Philip E. Aylward</name></noRegion></country><country name="Espagne"><region name="Catalogne"><name sortKey="Betriu, G Amadeo" sort="Betriu, G Amadeo" uniqKey="Betriu G" first="G. Amadeo" last="Betriu">G. Amadeo Betriu</name></region></country><country name="République tchèque"><region name="Bohême centrale"><name sortKey="Widimsky, Petr" sort="Widimsky, Petr" uniqKey="Widimsky P" first="Petr" last="Widimsky">Petr Widimsky</name></region></country><country name="Canada"><noRegion><name sortKey="Westerhout, Cynthia M" sort="Westerhout, Cynthia M" uniqKey="Westerhout C" first="Cynthia M." last="Westerhout">Cynthia M. Westerhout</name></noRegion><name sortKey="Armstrong, Paul W" sort="Armstrong, Paul W" uniqKey="Armstrong P" first="Paul W." last="Armstrong">Paul W. Armstrong</name><name sortKey="Armstrong, Paul W" sort="Armstrong, Paul W" uniqKey="Armstrong P" first="Paul W." last="Armstrong">Paul W. Armstrong</name><name sortKey="Armstrong, Paul W" sort="Armstrong, Paul W" uniqKey="Armstrong P" first="Paul W." last="Armstrong">Paul W. Armstrong</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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