Glycoprotein IIb/IIIa inhibitors significantly reduced the rate of death or nonfatal myocardial infarction compared with placebo during medical treatment (2.5% vs 3.8%; P<0.001) and post-PCI.
Meta-Analysis (n=12,296)
Yes
Effect estimate: 34% relative reduction
Absolute Event Rate: 2.5% vs 3.8%
p-value: p=<0.001
BACKGROUND: Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threatening cardiac complications in patients with acute coronary syndromes without ST-segment elevation and protect against thrombotic complications associated with percutaneous coronary interventions (PCIs). The question arises as to whether these 2 beneficial effects are independent and additive. METHODS AND RESULTS: We analyzed data from the CAPTURE, PURSUIT, and PRISM-PLUS randomized trials, which studied the effects of the GP IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban, respectively, in acute coronary syndrome patients without persistent ST-segment elevation, with a period of study drug infusion before a possible PCI. During the period of pharmacological treatment, each trial demonstrated a significant reduction in the rate of death or nonfatal myocardial infarction in patients randomized to the GP IIb/IIIa inhibitor compared with placebo. The 3 trials combined showed a 2.5% event rate in this period in the GP IIb/IIIa inhibitor group (N=6125) versus 3.8% in placebo (N=6171), which implies a 34% relative reduction (P<0.001). During study medication, a PCI was performed in 1358 patients assigned GP IIb/IIIa inhibition and 1396 placebo patients. The event rate during the first 48 hours after PCI was also significantly lower in the GP IIb/IIIa inhibitor group (4. 9% versus 8.0%; 41% reduction; P<0.001). No further benefit or rebound effect was observed beyond 48 hours after the PCI. CONCLUSIONS: There is conclusive evidence of an early benefit of GP IIb/IIIa inhibitors during medical treatment in patients with acute coronary syndromes without persistent ST-segment elevation. In addition, in patients subsequently undergoing PCI, GP IIb/IIIa inhibition protects against myocardial damage associated with the intervention.
Boersma et al. (Tue,) conducted a meta-analysis in Non-ST-elevation acute coronary syndromes (n=12,296). Glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban) vs. Placebo was evaluated on Death or nonfatal myocardial infarction during pharmacological treatment (34% relative reduction, p=<0.001). Glycoprotein IIb/IIIa inhibitors significantly reduced the rate of death or nonfatal myocardial infarction compared with placebo during medical treatment (2.5% vs 3.8%; P<0.001) and post-PCI.