Route-specific outcomes of glycoprotein IIb/IIIa inhibitor delivery during PCI for acute coronary syndrome: a meta-analysis of randomized trials

Background While intracoronary (IC) delivery of glycoprotein IIb/IIIa inhibitors (GPIs) has demonstrated clinical benefits following percutaneous coronary intervention (PCI), this approach may limit optimal drug-lesion contact, potentially contributing to no-reflow phenomena. The intralesional (IL) approach has emerged as a potentially superior alternative. This meta-analysis compares clinical outcomes between IC and IL administration of GPIs in acute coronary syndrome (ACS) patients undergoing PCI. Methods We performed a comprehensive systematic review of PubMed, Embase, and COCHRANE databases. Our analysis included randomized controlled trials (RCTs) that directly compared IL and IC GPI administration during PCI in ACS patients. Outcomes were analyzed using random effects models, with dichotomous variables expressed as relative risk (RR) and continuous variables as mean differences (MD). Results Nine RCTs (n=995 patients; IL=509, IC=486) met inclusion criteria. The IL approach demonstrated superior outcomes for several key parameters: TIMI grade III flow (RR=1.12, 95% CI 1.02-1.20, p<0.05), corrected TIMI frame count (MD=-4.63, 95% CI -8.83 to -0.43, p<0.05), and myocardial blush grade 3 (RR=1.34, 95% CI 1.15-1.57, p<0.05). No significant differences were observed between groups for complete ST-segment resolution, major adverse cardiovascular events (MACE), or bleeding outcomes (all p>0.05). Conclusions Our findings suggest preferential outcomes with IL GPI administration regarding coronary flow parameters. However, these results require validation through larger, multicenter RCTs to establish definitive clinical recommendations.