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Observational Study
. 2017 Aug 1;17(1):212.
doi: 10.1186/s12872-017-0636-9.

Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry

José M De la Torre Hernández  1 , Mario Sadaba Sagredo  2 , Miren Telleria Arrieta  3 , Federico Gimeno de Carlos  4 , Elena Sanchez Lacuesta  5 , Juan A Bullones Ramírez  6 , Javier Pineda Rocamora  7 , Victoria Martin Yuste  8 , Tamara Garcia Camarero  9 , Mariano Larman  3 , Jose R Rumoroso  2
Affiliations
Observational Study

Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry

José M De la Torre Hernández et al. BMC Cardiovasc Disord. .

Abstract

Background: Thrombolysis is still used when primary angioplasty is delayed for a long time, but 25%-30% of patients require rescue angioplasty (RA). There are no established recommendations for antithrombotic management in RA. This registry analyzes regimens for antithrombotic management.

Methods: A retrospective, multicenter, observational registry of consecutive patients treated with RA at 8 hospitals. All variables were collected and follow-up took place at 6 months.

Results: The study included 417 patients. Antithrombotic therapy in RA was: no additional drugs 22.3%, unfractionated heparin (UFH) 36.6%, abciximab 15.5%, abciximab plus UFH 10.5%, bivalirudin 5.7%, enoxaparin 4.3%, and others 4.7%. Outcomes at 6 months were: mortality 9.1%, infarction 3.3%, definite or probable stent thrombosis 4.3%, revascularization 1.9%, and stroke 0.5%. Mortality was related to cardiogenic shock, age > 75 years, and anterior location. The stent thrombosis rate was highest with bivalirudin (12.5% at 6 months). The incidence of bleeding at admission was high (14.8%), but most cases were not severe (82% BARC ≤2). Variables independently associated with bleeding were: femoral access (OR 3.30; 95% CI 1.3-8.3: p = 0.004) and post-RA abciximab infusion (OR 2.26; 95% CI 1.02-5: p = 0.04).

Conclusions: Antithrombotic treatment regimens in RA vary greatly, predominant strategies consisting of no additional drugs or UFH 70 U/kg. No regimen proved predictive of mortality, but bivalirudin was related to more stent thrombosis. There was a high incidence of bleeding, associated with post-RA abciximab infusion and femoral access.

Keywords: Acute myocardial infarction; Angioplasty; Anticoagulation; Thrombolytic therapy.

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Conflict of interest statement

Ethics approval and consent to participate

The registry was approved by the respective ethics committees of the participating centers as listed in first page and was in compliance with the Helsinki Declaration. All patients provided written informed consent for their clinical data to be used in a strictly anonymous way.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CRUSADE bleeding score in the study population
Fig. 2
Fig. 2
BARC >1 bleeding rate according to CRUSADE bleeding score
See this image and copyright information in PMC

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