Abstract
Abstract
Aims
The aim of this pooled sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial was to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated either with clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor.
Methods and results
For the current analysis the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. 856 patients were eligible for analysis. Of these, 507 patients (59.2%) received clopidogrel, 178 patients (20.8%) prasugrel and 171 patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ significantly between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60–1.09, padj = 0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65–1.15, padj = 0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20 -0.69, padj = 0.002) and not significantly different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43 -1.24, padj = 0.24).
Conclusion
This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that acute therapy with either clopidogrel, prasugrel or ticagrelor is no independent predictor of 1-year mortality. Treatment with ticagrelor seems independently associated with less in-hospital moderate and severe bleeding events compared to clopidogrel. This finding might be due to selection bias and should be interpreted with caution.
Graphic abstract
Funder
Deutsche Herzstiftung
FP7 Health
Institut für Herzinfarktforschung
Deutsche Forschungsgemeinschaft
Deutsche Gesellschaft für Kardiologie-Herz und Kreislaufforschung.
Deutsches Zentrum für Herz-Kreislaufforschung
Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte
Universität Leipzig
Maquet Cardiopulmonary AG
Teleflex Medical, Everett, MA, USA
Ludwig-Maximilians-Universität München
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,General Medicine
Reference19 articles.
1. Backhaus T, Fach A, Schmucker J, Fiehn E, Garstka D (2018) Stehmeier J Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol 107(5):371–379
2. Rathod KS, Koganti S, Iqbal MB, Jain AK, Kalra SS, Astroulakis Z (2017) Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. Eur Heart J Acute Cardiovasc Care 7(1):16–27
3. Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367(14):1287–1296
4. Scherer C, Kupka D, Stocker TJ, Joskowiak D, Scheuplein H, Schönegger CM (2020) Isoflurane sedation in patients undergoing venoarterial extracorporeal membrane oxygenation treatment for cardiogenic shock-an observational propensity-matched study. Crit Care Explor March 2020(3):e00086
5. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H (2017) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献