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Association Between Platelet Glycoprotein IIb/IIIa Inhibition and In-Hospital Outcomes in ST-Elevation Myocardial Infarction Patients Treated with Coronary Thrombus Aspiration: Findings from the CCC-ACS Project

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Abstract

Purpose

Thrombus aspiration in ST-elevation myocardial infarction (STEMI) with high thrombus burden did not improve clinical outcomes. The clinical efficacy of the bailout use of platelet glycoprotein IIb/IIIa inhibitors (GPIs) in this clinical scenario remains unknown.

Methods

We assessed associations between GPI use and in-hospital major bleeds, ischemic events, and mortality among STEMI patients treated with percutaneous coronary intervention (PCI) and thrombus aspiration in a nationwide acute coronary syndrome registry (the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project).

Results

A total of 5896 STEMI patients who received thrombus aspiration were identified, among which 56.3% received GPI therapy. In a 1-to-1 propensity-score-matched cohort, compared with STEMI patients not treated with GPI, GPI use was associated with a 69% increase in major in-hospital bleeds, with an odds ratio (OR) of 1.69, a 95% confidence interval (CI) of 1.08 to 2.65, and a nonsignificant reduction in ischemic events (OR: 0.61, 95% CI: 0.36 to 1.06), as well as a neutral effect on mortality (OR: 0.93, 95% CI: 0.55 to 1.58). However, among patients aged < 60 years, GPI use was associated with a reduction in ischemic events (OR: 0.27, 95% CI: 0.08 to 0.98), and no significant increase in major bleeds was observed.

Conclusion

In a nationwide registry, routine use of GPI following thrombus aspiration was not associated with reduced in-hospital ischemic events and mortality but at the cost of increased major bleeding. However, for patients aged < 60 years, there may be a potential net benefit.

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Acknowledgements

The article was written on behalf of the CCC-ACS project investigators.

Funding

This work was supported by a collaborative program of the American Heart Association and the Chinese Society of Cardiology. The American Heart Association was funded by Pfizer and AstraZeneca for the quality improvement initiative through an independent grant for learning and change. This work was also supported by the National Key R&D Program of China (Nos. 2020YFC2004700, 2020YFC2004706), Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-069C), and Tianjin Municipal Science and Technology Commission (19JCQNJC11500).

Author information

Author notes

  1. Wennan Liu and Ziping Li are authors contributed equally to this work

Authors and Affiliations

  1. Department of Cardiology, Tianjin Medical University General Hospital, 154, Anshan Road, Heping District, 154, Anshan Road, Heping District, Tianjin, 300052, China

    Wennan Liu, Ziping Li, Tianqi Yang, Geru A, Haonan Sun, Hangkuan Liu, Xiwen Song, Zhengyang Jin, Linjie Li, Yongle Li, Xin Zhou & Qing Yang

  2. Department of Epidemiology, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Yongchen Hao, Jing Liu & Dong Zhao

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  1. Wennan Liu
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Consortia

on behalf of the CCC-ACS investigators

  • Aihua Li
  • , Bao Li
  • , Biao Xu
  • , Guangshu Han
  • , Bin Li
  • , Bin Liu
  • , Bin Wang
  • , Bing Fu
  • , Bo Yu
  • , Bosong Yang
  • , Caidong Luo
  • , Changqian Wang
  • , Changyong Liu
  • , Chuanliang Liang
  • , Chuanyu Gao
  • , Chunlin Lai
  • , Chuntong Wang
  • , Chunyan Zhang
  • , Chunyang Wu
  • , Congliang Zhang
  • , Cui Bin
  • , Lan Huang
  • , Daoquan Peng
  • , Dawen Xu
  • , Di Wu
  • , Dongmei Zhu
  • , Dongsheng Chai
  • , Dongyan Li
  • , Fakuan Tang
  • , Jun Xiao
  • , Fang Zhao
  • , Fangfang Huang
  • , Fanju Meng
  • , Fengwei Li
  • , Fudong Gan
  • , Gang Xu
  • , Gengsheng Sang
  • , Genshan Ma
  • , Guixia Zhang
  • , Guizhou Tao
  • , Guo Li
  • , Guoduo Chen
  • , Guoqin Xin
  • , Guoqing Li
  • , Guosheng Fu
  • , Guoxiong Chen
  • , Hailong Lin
  • , Haiping Guo
  • , Haiyun Lin
  • , Hong Jiang
  • , Hong Liu
  • , Hong Luan
  • , Hong Zhang
  • , Honghua Deng
  • , Hongwei Li
  • , Honhju Wang
  • , Hualing Liu
  • , Hui Dong
  • , Hui Liu
  • , Huifang Zhang
  • , Huifeng Wang
  • , Huimin Chu
  • , Jiabin Xi
  • , Jian Yang
  • , Jianfeng Ye
  • , Jianhao Li
  • , Jianhong Tao
  • , Jianwen Liu
  • , JiaoMei Yang
  • , Jiawang Ding
  • , Jiayi Tong
  • , Jie Chen
  • , Jie Jiang
  • , Jie Yang
  • , Jifu Li
  • , Jinchuan Yan
  • , Jing Hu
  • , Jing Xu
  • , Jingfeng Wang
  • , Jinglan Diao
  • , Jingshan Zhao
  • , Jinru Wei
  • , Jinxing Yi
  • , Jinzi Su
  • , Jiong Tang
  • , Jiyan Chen
  • , Jiyan Yin
  • , Juexin Fan
  • , Jun Guan
  • , Junbo Ge
  • , Junming Liu
  • , Junping Deng
  • , Junping Fang
  • , Junxia Li
  • , Kaihong Chen
  • , Kalan Luo
  • , Keng Wu
  • , Lang Ji
  • , Lang Li
  • , Li Jiang
  • , Li Wei
  • , Lijun Meng
  • , Likun Ma
  • , Lilong Tang
  • , Lin Wang
  • , Lin Wei
  • , Ling Li
  • , Ling Tao
  • , Liqiong Yang
  • , Lirong Wu
  • , Man Zhang
  • , Kaiming Chen
  • , Meisheng Lai
  • , Miao Tian
  • , Mingcheng Bai
  • , Minghua Han
  • , Moshui Chen
  • , Naiyi Liang
  • , Nan Jia
  • , Peiying Zhang
  • , Peng Qu
  • , Pengfei Zhang
  • , Ping Chen
  • , Ping Hou
  • , Ping Xie
  • , Ping Zhang
  • , Pingshuan Dong
  • , Qiang Wu
  • , Qiang Xie
  • , Qiaoqing Zhong
  • , Qichun Wang
  • , Qinfeng Su
  • , Rong Chang
  • , Rong Lin
  • , Ruiping Zhao
  • , Shaobin Jia
  • , Shaoping Nie
  • , Shaowu Ye
  • , Shenghu He
  • , Shengyong Chen
  • , Shixin Ma
  • , Shuangbin Li
  • , Shuanli Xin
  • , Shudong Xia
  • , Shuhua Zhang
  • , Shuqiu Qu
  • , Shuren Ma
  • , Siding Wang
  • , Songbai Li
  • , Suxin Luo
  • , Tao Liu
  • , Tao Zhang
  • , Tian Tuo
  • , Tianchang Li
  • , Tianlun Yang
  • , Tianmin Du
  • , Tongguo Wu
  • , Wei Liu
  • , Wei Mao
  • , Wei Tuo
  • , Wei Wang
  • , Weihong Jiang
  • , Weijian Huang
  • , Weijun Liu
  • , Weiqing Fan
  • , Weiting Xu
  • , Wenhua Lin
  • , Xi Su
  • , Xia Chen
  • , Xianan Zhang
  • , Xianghua Fu
  • , Xiangjun Yang
  • , Xianxian Zhao
  • , Xiaochuan Ma
  • , Xiaofei Sun
  • , Xiaojun Wang
  • , Xiaolan Li
  • , Xiaolei Li
  • , Xiaoli Yang
  • , Xiaoping Chen
  • , Xiaoping Chen
  • , Xiaoqin Zhang
  • , Xiaoshu Cheng
  • , Xiaowei Peng
  • , Xiaowen Ma
  • , Xiaoyong Qi
  • , Xiaoyun Feng
  • , Ximing Chen
  • , Xin Tang
  • , Xingsheng Tang
  • , Xingsheng Zhao
  • , Xiufeng Chen
  • , Xudong Li
  • , Xue Li
  • , Xuebo Liu
  • , Xuemei Peng
  • , Yaling Han
  • , Yan Wang
  • , Yanbo Niu
  • , Yang Yu
  • , Yang Zheng
  • , Yanli Wang
  • , Yanlie Zheng
  • , Yansong Guo
  • , Yanzong Yang
  • , Yi Huang
  • , Yin Liu
  • , Ying Guo
  • , Yingchao Luo
  • , Yinglu Hao
  • , Yingxian Sun
  • , Yingzhong Lin
  • , Yitong Ma
  • , Yong Li
  • , Yongdong Li
  • , Yonglin Zhang
  • , Yuanzhe Jin
  • , Yue Li
  • , Yuehua Huang
  • , Yuemin Sun
  • , Yuheng Yang
  • , Yuhua Zhu
  • , Yuhuan Shi
  • , Yulan Zhao
  • , Yuqing Hou
  • , Zeqi Zheng
  • , Zesheng Xu
  • , Zewei Ouyang
  • , Zeyuan He
  • , Zhan Lv
  • , Zhanquan Li
  • , Zhaofa He
  • , Zheng Ji
  • , Zheng Zhang
  • , Zhenguo Ji
  • , Zhenqi Su
  • , Zhenyu Yang
  • , Zhihong Ou
  • , Zhijian Yang
  • , Zhiming Yang
  • , Zhirong Wang
  • , Zhiyuan Song
  • , Zhongshan Wang
  •  & Zuyi Yuan

Contributions

XZ, QY, and YL conceived and designed the study, supervised the analysis process, interpreted the data, and revised the manuscript. WL and ZL analyzed the data and drafted the manuscript. WL, ZL, TY, GA, HS, HL, XS, ZJ, and LL helped to analyze the data and table and figure generation. YH, JL, and DZ supervised the CCC-ACS project and interpreted the data. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xin Zhou or Qing Yang.

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Ethics Approval

The CCC-ACS project was approved by the institutional review board of Beijing Anzhen Hospital, Capital Medical University, with a waiver for informed consent.

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The authors declare no competing interests.

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A complete list of CCC-ACS investigators is given at the Supplemental Table 11.

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Liu, W., Li, Z., Yang, T. et al. Association Between Platelet Glycoprotein IIb/IIIa Inhibition and In-Hospital Outcomes in ST-Elevation Myocardial Infarction Patients Treated with Coronary Thrombus Aspiration: Findings from the CCC-ACS Project. Cardiovasc Drugs Ther 38, 315–325 (2024). https://doi.org/10.1007/s10557-022-07398-w

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