Intravenous antithrombotics in AMI-CS reduced 30-day MACE from 44.9% to 29.1% (wHR 0.59) without increased major bleeding risk (wHR 0.78, NS).
Does intravenous antithrombotic administration reduce MACE in patients with AMI-CS undergoing coronary angiography?
In patients with AMI complicated by cardiogenic shock, the use of intravenous antithrombotics during PCI is associated with a lower risk of 30-day ischemic events without increasing major bleeding compared to oral antithrombotics alone.
Absolute Event Rate: 0% vs 0%
Abstract Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a high ischemic and bleeding risk presentation in which oral antiplatelet therapy may be less effective. Intravenous antithrombotics (IV), such as cangrelor or GPIIb-IIIa inhibitors, can be an alternative, but there is a lack of data regarding their efficacy and safety in this population. Purpose To evaluate the efficacy and safety of IV antithrombotic agents in patients with AMI-CS. Methods Using the ACTION-SHOCK cohort, we included consecutive patients hospitalized between 2012 and 2023 with AMI-CS admitted for coronary angiography within 24 hours of admission. IV antithrombotic was defined as the administration during primary percutaneous coronary intervention (PCI) of parenteral cangrelor or anti GPIIb-IIIa agent. Using an Inverse Probability Weighting (IPW) approach, we evaluated the association between IV treatment and major adverse cardiovascular events (MACE) as well as major bleeding at 30 days after admission. MACE was defined by the composite of all-cause death, ischemic stroke, myocardial infarction, or stent thrombosis. Major bleeding was defined as BARC (Bleeding Academic Research Consensus) grade 3, 4, or 5. Results Among 389 patients with AMI-CS admitted to the catheterization laboratory within 24 hours of admission, 139 (35.7%) patients received IV therapy in whom 32 (23.0%) received cangrelor and 116 (83.5%) received any anti GPIIb-IIIa. Only oral antithrombotic were administered for 250 (64.3%) patients. Coronary intervention (PCI) was performed in 136 (97.8%) patients in the IV group and 177 (70.8%) patients in the oral group. After adjustment, IV agent administration was associated with a lower risk of MACE at 30 days (29.1% vs 44.9% - wHR: 0.59, 95% CI: 0.41-0.84). There was no significant difference in the risk of major bleedings (33.9% for IV group vs 42.1% for oral group - wHR: 0.78, 95% CI: 0.54-1.13). The effect of treatment at 30 days was consistent across STEMI sub-group (p for interaction 0.42 on MACE and 0.52 on major bleeding). Conclusion In patients with AMI-CS undergoing coronary angiography, intra venous antithrombotic agent administration was associated with lower rates of ischemic outcomes without association with major bleeding complications at 30 days.Kaplan Meier estimates of MACE outcome Kaplan Meier estimates of major bledding
Elhadad et al. (Sat,) reported a other. Intravenous antithrombotics in AMI-CS reduced 30-day MACE from 44.9% to 29.1% (wHR 0.59) without increased major bleeding risk (wHR 0.78, NS).