A study published in Journal of American College of Cardiology: Cardiovascular Interventions evaluated the association between intravenous (IV) antiplatelet therapy and 30-day cardiovascular and bleeding outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS).
This observational cohort analysis included 389 patients treated between 2012 and 2023 who underwent catheterization within 24 hours of presentation. IV antiplatelet therapy (cangrelor or glycoprotein IIb/IIIa inhibitors) was administered to 139 patients (35.7%). Inverse probability weighting was used to adjust for baseline differences.
The primary endpoint was 30-day major adverse cardiovascular events (MACE), defined as all-cause death, ischemic stroke, myocardial infarction, or stent thrombosis. MACE occurred in 29.1% of patients receiving IV therapy (95% CI 21.7%–38.5%) compared with 44.9% of those not receiving IV therapy (95% CI 38.8%–51.6%). Weighted analysis showed an association with lower MACE risk (HR 0.59; 95% CI 0.41–0.84).
Major bleeding occurred in 33.9% of IV-treated patients and 42.1% of non-IV patients. No statistically significant increase in bleeding was observed after adjustment (HR 0.78; 95% CI 0.54–1.13). Findings were consistent across STEMI and non-STEMI subgroups.
However, treatment allocation was not randomized and thus, the residual confounding cannot be excluded. Study also had modest sample size. The results demonstrate association rather than causation.