A-60 | Intralesional vs intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials

Intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) has been associated with improved outcomes after percutaneous coronary intervention (PCI). However, IC administration leads to a sub-optimal contact between the lesion and GPIs, leading to no-re flow, for which intralesional (IL) route has been proposed. We conducted a meta-analysis to evaluate clinical outcomes in IC vs IL routes for GPIs administration in patients with acute coronary syndromes (ACS) undergoing PCI. A systematic literature search was conducted across Pubmed, Embase and COCHRANE. The inclusion criteria was randomized controlled trials (RCTs) that compared IL and IC routes for PCI in ACS patients. Relative risk (RR) and Mean differences (MD) were used to pool the dichotomous and continuous outcomes respectively using the random effects model. Nine RCTs (n=995) comparing the IL (n=509) and the IC (n=486) routes were included. IL route showed better results in terms of TIMI grade III flow [RR=1.12, 95% CI=1.02-1.20, p<0.05], corrected TIMI frame count (CFTC) [MD=-4.63, 95% CI=-8.83, -0.43, p<0.05] and myocardial blush grade 3 (MCB3) [RR=1.34, 95% CI=1.15-1.57, p<0.05]. The results were comparable across the two groups for complete ST segment resolution, major adverse cardiovascular events (MACE), in-hospital bleeding events, major bleeding, minor bleeding and thrombocytopenia (p >0.05). IL administration of GPIs is favorable in terms of TIMI grade III flow, CTFC and MCB3. However, large multicenter RCTs are needed for definitive statistical evidence.