强效P2Y12受体拮抗剂时代，机械通气的心肌梗死所致心源性休克患者使用糖蛋白IIb/IIIa受体抑制剂的情况
GP IIb/IIIa Receptor Inhibitors in Mechanically Ventilated Patients with Cardiogenic Shock due to Myocardial Infarction in the Era of Potent P2Y12 Receptor Antagonists.
作者信息
Kanic Vojko, Kompara Gregor, Suran David
机构信息
Department of Cardiology and Angiology, Division of Internal Medicine, University Medical Center Maribor, 2000 Maribor, Slovenia.
出版信息
J Clin Med. 2022 Dec 14;11(24):7426. doi: 10.3390/jcm11247426.
Objective: To investigate the association between GP IIb/IIIa receptor inhibitors (GPI) and mortality and bleeding in patients with cardiogenic shock (CS) due to myocardial infarction (MI) who were mechanically ventilated on admission. Methods: We retrospectively divided 153 patients into two groups (with or without GPI). Thirty-day and one-year all-cause mortality and bleeding were studied. Results: The observed 30-day and one-year all-cause mortality were similar in both groups [54 (69.2%) with GPI vs. 62 (82.7%) without GPI; p = 0.06, and 60 (76.9%) with GPI vs. 64 (85.3%) without GPI; p = 0.22, respectively]. Patients with GPI suffered fewer unsuccessful PCI (TIMI 0/1 was 10% in the GPI group vs. 57% in the group without GPI), experienced more improvements in TIMI ≥ 1 flow [68 (87.2%) in the GPI group vs. 38 (50.7%) without GPI; p < 0.0001], and they achieved better cerebral performance category (CPC) scores (1.61 ± 0.99 with GPI vs. 2.76 ± 1.64 without GPI; p = 0.005). The bleeding rate was similar in patients with and without GPI [33 (42.3%) vs. 31 (41.3%): p = 1.00], in patients with P2Y12 receptor antagonists (P2Y12) [18 (46.1%) with GPI vs. 21 (46.7%) without GPI; p = 1.00], and in patients with potent P2Y12 [8 (30.8%) with GPI vs. 9 (37.5%) without GPI; p = 0.77]. Conclusions: Due to the study design (limited sample size, retrospective inclusion with high risk of selection bias), our analysis does not allow us to draw conclusions about the effectiveness of GPI in this context. Despite all these limitations, GPI were associated with improved TIMI flow after PCI in our multivariable model without increasing bleeding rates. In addition, better CPC scores were observed, but no association between GPI and outcome was found. Our analysis suggests that selective use of GPI may be beneficial in mechanically ventilated patients with MI in CS without additional bleeding risk, even in the era of potent P2Y12.
目的
探讨糖蛋白IIb/IIIa受体抑制剂（GPI）与因心肌梗死（MI）导致的心源性休克（CS）且入院时接受机械通气患者的死亡率和出血之间的关联。方法：我们回顾性地将153例患者分为两组（使用或未使用GPI）。研究30天和1年的全因死亡率及出血情况。结果：两组观察到的30天和1年全因死亡率相似[使用GPI组54例（69.2%），未使用GPI组62例（82.7%）；p = 0.06，使用GPI组60例（76.9%），未使用GPI组64例（85.3%）；p = 0.22]。使用GPI的患者未成功进行经皮冠状动脉介入治疗（PCI）的情况较少（GPI组TIMI 0/1为10%，未使用GPI组为57%），TIMI≥1级血流改善更多[GPI组68例（87.2%），未使用GPI组38例（50.7%）；p < 0.0001]，且他们获得了更好的脑功能分类（CPC）评分（使用GPI组为1.61±0.99，未使用GPI组为2.76±1.64；p = 0.005）。使用和未使用GPI的患者出血率相似[33例（42.3%）对31例（41.3%）：p = 1.00]，使用P2Y12受体拮抗剂（P2Y12）的患者中[使用GPI组18例（46.1%），未使用GPI组21例（46.7%）；p = 1.00]，以及使用强效P2Y12的患者中[使用GPI组8例（30.8%），未使用GPI组9例（37.5%）；p = 0.77]。结论：由于研究设计（样本量有限、回顾性纳入且存在选择偏倚的高风险），我们的分析无法在此背景下就GPI的有效性得出结论。尽管存在所有这些局限性，但在我们的多变量模型中，GPI与PCI后TIMI血流改善相关，且未增加出血率。此外，观察到更好的CPC评分，但未发现GPI与结局之间存在关联。我们的分析表明，即使在强效P2Y12的时代，选择性使用GPI可能对CS中MI且接受机械通气且无额外出血风险的患者有益。
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