Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical
outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance
that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy
and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not
been fully investigated. 1,630 STEMI patients who underwent primary percutaneous coronary
intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients
were divided in three groups: no GPI, GPI administration routinely before primary
PCI, and GPI administration in bailout situations. The primary efficacy outcome was
a composite of death, myocardial infarction, urgent target revascularization, and
definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass
graft (CABG)-related PLATO major bleeding at 30 days. Compared with no GPI (n = 930),
routine GPI (n = 525) or bailout GPI (n = 175) was not associated with an improved
primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p
= 0.58). After multivariate analysis, the use of GPI in bailout situations was associated
with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio
[OR] 2.96, 95% confidence interval [CI] 1.32-6.64; p = 0.03). However, routine GPI
use compared with no GPI was not associated with a significant increase in bleeding
(OR 1.78, 95% CI 0.88-3.61; p = 0.92). Use of GPIs in addition to ticagrelor in STEMI
patients was not associated with an improvement in 30-day ischemic outcome. A significant
increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who
received GPIs in a bailout situation.
