Author + information
- Farrukh Hussain,
- Seeger Shen,
- Kerrett Wallace,
- Ali Bagherli,
- Roger K. Philipp,
- James W. Tam and
- Davinder S. Jassal
Previous literature has demonstrated the safety of abbreviated GPIIbIIIa infusion in elective PCI. There is no data to date on the safety of abbreviated infusion of GP IIbIIIa inhibition in the setting of primary PCI for STEMI.
Methods and Results
A retrospective cohort of STEMI patients undergoing primary PCI from June 2009 - June 2011 was analyzed. Detailed demographic, intervention and complication data was collected. A logistic regression model was utilized to identify univariate and multivariate predictors of a pre-specified primary combined endpoint of death/vascular complication/transfusion/stent thrombosis. 66 patients with a mean age of 61 ± 13 years (27% female, 26% diabetic) were identified. Six patients had cardiogenic shock on admission (9%). Symptom onset to device time was 312±318 min and lab to device time was 19±10 min. There were 6 patients (9%) with a pre lab cardiac arrest. Mean LVEF was 53±12 % and peak CK was 1991±2130U. Successful PCI (TIMI 3 flow and residual stenosis ≤ 20%) was achieved in 64 (97%). Thrombectomy was performed in 45 (68%) patients. Stents were deployed in 65 (98%) with 1.6±0.5 stents (mean length 31±19) mm delivered to a mean of 1.1±0.4 lesions. Mean duration of eptifibatide was 3.8±3.3 hours. Femoral access was utilized in 60 patients (91%) with closure devices in 39 (59%) and IABP used in 6 (9%). Three patients underwent index admission CABG (2 elective, 1 urgent). There were 3 in-hospital deaths due to cardiogenic shock (5%). There were no recurrent infarctions or stent thrombosis. There was 1 AV fistula and 1 small retroperitoneal bleed not requiring surgery or transfusion. Three patients received transfusion (2 post CABG, 1 GI bleed).
Univariate predictors of death/vascular complication/stent thrombosis/transfusion include: pre-lab arrest (p=0.0006), IABP use (p=0.014), transfer patient (p=0.002) and shock on admission (p=0.03); the only independent predictor was pre-lab arrest (p=0.03, OR 11.1 (95% CI 1.2-129.6).
Abbreviated duration GPIIbIIIa may be a safe and novel alternate during STEMI. Major bleeding post infarct PCI was low with no access site related transfusion or surgery and no stent thrombosis.
- 2013 American College of Cardiology Foundation