Pharmacologie cardiovasculaire : libre accès

Abstrait

Glycoprotein Iib/Iiia Inhibitors in Acute ST-Segment Elevation Myocardial Infarction: Evaluation of Clinical Practice and Cost/Efficacy Analysis

Cuny P, Benmiloud S, Oliary J, Dillinger JG, Sideris G, Henry P and Manzo-Silberman S*

Associated to primary percutaneous coronary intervention (pPCI), pharmacotherapy in acute ST-Segment elevation myocardial infarction (STEMI) patients have transformed the management of the acute phase. Use of glycoprotein IIb/IIIa inhibitors (GPI) remains debatable, level of guidelines has been modified in the successive editions of guidelines. In the latest European Society of Cardiology guidelines, GPI have a IIb B level in upstream use and IIa C in bail out during pPCI procedure. In front of the varying recommendations, we analysed clinical characteristics of patients with ST-Segment elevation myocardial infarction according to the use of GPI. We evaluate complications during hospitalization, particularly bleeding events. The cost of patients’ management was also analysed.

We conducted a retrospective, descriptive and monocentric study from January 2010 to December 2012 including all consecutive STEMI patients with symptoms evolving for less than 12 hours treated by pPCI.

GPI were administered as recommended in patients with high thrombotic risk, low bleeding risk, with early presentation and more likely anterior location. Despite an initial more severe clinical presentation, no statistical difference among each group on in-hospital complications and duration of hospital stay was observed. Nevertheless patients treated with abciximab have a significant higher cost of overall management compared to HNF only (+30%) or other GPI (+37%). In selected clinical indications, in line with the European guidelines, GPI use appears safe, efficient and cost effective with regards to eptifibatide/tirofiban.