Efficacy and Safety of Intravenous Antiplatelet Therapy in Acute Myocardial Infarction With Cardiogenic Shock

Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) requires potent antiplatelet therapy while minimizing bleeding complications. Despite the increased use of intravenous (IV) antiplatelet therapy in this setting, data regarding its use remain limited.

The aim of this study was to evaluate the effectiveness and safety of IV antiplatelet therapy in patients with AMI-CS.

Using the ACTION-SHOCK cohort, patients hospitalized between 2012 and 2023 with AMI-CS were included. IV antiplatelet therapy was defined as the administration of cangrelor or glycoprotein IIb/IIIa inhibitors. Using an inverse probability weighting approach, the associations between IV antiplatelet strategy and major adverse cardiovascular events (MACE) as well as major bleeding at 30 days were assessed. MACE were defined as a composite of all-cause death, ischemic stroke, myocardial infarction, and stent thrombosis.

Among 389 patients with AMI-CS admitted to the catheterization laboratory within 24 hours of admission, 139 (35.7%) received IV antiplatelet therapy. The IV strategy was associated with a lower risk for MACE at 30 days (29.1% [41 of 139] [95% CI: 21.7%-38.5%] vs 44.9% [112 of 250] [95% CI: 38.8%-51.6%]; inverse probability weighting HR: 0.59; 95% CI: 0.41-0.84) without an increase in major bleeding (33.9% [42 of 139] [95% CI: 25.5%-44.1%] vs 42.1% [85 of 250] [95% CI: 35.4%-49.5%]; HR: 0.78; 95% CI: 0.54-1.13). These results were consistent in patients with ST-segment elevation myocardial infarctions, with persistent MACE reduction and no increase in bleeding, compared with those with non-ST-segment elevation myocardial infarction (P for interaction = 0.42 and 0.52).

In AMI-CS patients undergoing angiography, IV antiplatelet therapy was associated with a lower ischemic risk without an increase in major bleeding at 30 days.