Glycoprotein 2c/3a inhibitor (GPI) use in patients following angioplasty procedures has been associated with a reduced risk of all-cause in-hospital mortality, but an increased risk of bleeding, according to a study published in JACC: Cardiovascular Interventions.
Researchers used data from the US National Cardiovascular Data Registry CathPCI Registry to assess records from 970,865 patients with an acute coronary syndrome between July 2009 and September 2011.
Despite advances in stent design and new anticoagulants, such as bivalirudin, the study found that almost one-third of cases in the study were treated with GPI.
After adjusting for many factors, including age, gender, race, insurance status, smoking status, family history of premature coronary artery disease and prior heart attack, relative risk reductions in mortality ranged from 10-28%. The risk reduction in mortality was enhanced in patients with myocardial infarction. However, after risk adjustments, GPI use was associated with an increased risk of major bleeding.
“These findings suggest that in the modern era of angioplasty, there may still be a role for the judicious use of GPI in high-risk patients, particularly if heparin, instead of bivalirudin, is used for anticoagulation, as it was in over one-half of patients included in this study,” says David M. Safley, the study’s lead author and associate professor of medicine at the University of Missouri-Kansas City.
This registry-based study was able to address some of the limitations of previous randomised trials on GPI, which included mostly lower-risk patients and did not measure mortality, Safley said.
In an accompanying editorial, A. Michael Lincoff, vice-chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic, noted the limitations due to the observational nature of the analysis. “Without randomisation, any observed associations between the treatment variable (GPI) and outcome cannot be proven to be causative,” Lincoff writes.
While acknowledging the robustness of the statistical methods used, Lincoff says, “There is no advantage of GPI over bivalirudin, and the latter strategy reduces bleeding.”