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Efficacy of pre-hospital use of glycoprotein IIb/IIIa inhibitors in ST-segment elevation myocardial infarction before mechanical reperfusion in a rapid-transfer network (from the Acute Myocardial Infarction Registry of Brittany).

Abstract
Previous studies investigating prehospital use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-segment elevation myocardial infarction reached conflicting conclusions. The benefit of this strategy in addition to in-ambulance loading of dual-antiplatelet therapy remains controversial. The aim of this study was to analyze data from a prospective registry of patients with ST-segment elevation myocardial infarctions admitted <24 hours after symptom onset (July 2006 to May 2012). A total of 2,052 patients managed in a physician-staffed mobile intensive care unit (MICU)<12 hours after symptom onset and scheduled for primary percutaneous coronary intervention (PPCI) were retrospectively included. Patients who received GPIs in the MICU were compared with those who did not. The primary end point was infarct-related artery patency, defined as pre-PPCI Thrombolysis In Myocardial Infarction (TIMI) flow grade 3. GPIs were administered in the MICU to 737 patients (36%), including 430<2 hours after symptom onset, and 1,315 patients (64%) did not received prehospital GPIs. Pre-PPCI TIMI flow grade 3 rate was lower in patients treated in the MICU (17.2% vs 21.3%, p=0.03) because of patients treated >2 hours after symptom onset, of whom only 12.7% reached the primary end point. There was no significant difference between groups in the rate of in-hospital major adverse cardiac events. In conclusion, prehospital GPI use in patients with ST-segment elevation myocardial infarctions<12 hours after symptom onset scheduled for PPCI neither improved pre-PPCI infarct-related artery patency nor reduced in-hospital major adverse cardiac events.
AuthorsVincent Auffret, Emmanuel Oger, Guillaume Leurent, Emmanuelle Filippi, Isabelle Coudert, Jean Philippe Hacot, Philippe Castellant, Antoine Rialan, Régis Delaunay, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marc Bedossa, Dominique Boulmier, Marielle Le Guellec, Hervé Le Breton
JournalThe American journal of cardiology (Am J Cardiol) Vol. 114 Issue 2 Pg. 214-23 (Jul 15 2014) ISSN: 1879-1913 [Electronic] United States
PMID24878117 (Publication Type: Journal Article, Multicenter Study, Observational Study)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Chemical References
  • Peptides
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • eptifibatide
Topics
  • Ambulances
  • Anterior Wall Myocardial Infarction (drug therapy, physiopathology, radiography)
  • Coronary Angiography
  • Dose-Response Relationship, Drug
  • Electrocardiography
  • Emergency Medical Services (methods)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Reperfusion (methods)
  • Outpatients
  • Peptides (administration & dosage)
  • Platelet Aggregation Inhibitors (administration & dosage)
  • Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
  • Registries
  • Thrombolytic Therapy (methods)
  • Time Factors
  • Treatment Outcome

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