Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: Insights from the APEX-AMI trial

Kurt Huber, David Holmes, Arnoud W. Van 'T Hof, Gilles Montalescot, Philip E. Aylward, G. Amadeo Betriu, Petr Widimsky, Cynthia M. Westerhout, Christopher B. Granger, Paul W. Armstrong

Research output: Contribution to journalArticle

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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 resultsIn 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.

Original languageEnglish (US)
Pages (from-to)1708-1716
Number of pages9
JournalEuropean heart journal
Volume31
Issue number14
DOIs
StatePublished - Jul 1 2010

Fingerprint

Platelet Glycoprotein GPIIb-IIIa Complex
Percutaneous Coronary Intervention
Myocardial Infarction
tirofiban
Catheterization
pexelizumab
Confidence Intervals
Shock
Clinical Trials
Pharmacology
Hemorrhage

Keywords

  • Coronary angioplasty
  • Glycoprotein IIb/IIIa inhibitors
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Huber, K., Holmes, D., Van 'T Hof, A. W., Montalescot, G., Aylward, P. E., Betriu, G. A., ... Armstrong, P. W. (2010). Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: Insights from the APEX-AMI trial. European heart journal, 31(14), 1708-1716. https://doi.org/10.1093/eurheartj/ehq143

Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention : Insights from the APEX-AMI trial. / Huber, Kurt; Holmes, David; Van 'T Hof, Arnoud W.; Montalescot, Gilles; Aylward, Philip E.; Betriu, G. Amadeo; Widimsky, Petr; Westerhout, Cynthia M.; Granger, Christopher B.; Armstrong, Paul W.

In: European heart journal, Vol. 31, No. 14, 01.07.2010, p. 1708-1716.

Research output: Contribution to journalArticle

Huber, K, Holmes, D, Van 'T Hof, AW, Montalescot, G, Aylward, PE, Betriu, GA, Widimsky, P, Westerhout, CM, Granger, CB & Armstrong, PW 2010, 'Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: Insights from the APEX-AMI trial', European heart journal, vol. 31, no. 14, pp. 1708-1716. https://doi.org/10.1093/eurheartj/ehq143
Huber, Kurt ; Holmes, David ; Van 'T Hof, Arnoud W. ; Montalescot, Gilles ; Aylward, Philip E. ; Betriu, G. Amadeo ; Widimsky, Petr ; Westerhout, Cynthia M. ; Granger, Christopher B. ; Armstrong, Paul W. / Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention : Insights from the APEX-AMI trial. In: European heart journal. 2010 ; Vol. 31, No. 14. pp. 1708-1716.
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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 resultsIn 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.",
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AU - Montalescot, Gilles

AU - Aylward, Philip E.

AU - Betriu, G. Amadeo

AU - Widimsky, Petr

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N2 - 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 resultsIn 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.

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