Efficacy and safety of intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndromes: a meta-analysis of randomized controlled trials

BACKGROUND: Intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) after percutaneous coronary intervention (PCI) have shown better outcomes than intravenous administration. However, limited data exist comparing intracoronary versus intralesional GPI delivery during PCI for acute coronary syndromes (ACS). METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials comparing intralesional and intracoronary GPI administration in ACS patients undergoing PCI. Odds ratios (ORs) and mean differences were used to combine dichotomous and continuous outcomes, respectively, using a random-effects model. Analyses were conducted in RevMan 5.4 and CRAN-R. RESULTS: Nine randomized controlled trials comparing the intralesional (n = 509) with intracoronary route (n = 486) were included. In the primary analysis, the intralesional route demonstrated significantly better postprocedural thrombolysis in myocardial infarction (TIMI) grade 3 flow [OR = 2.38, 95% confidence interval (CI) = 1.52-3.72, P = 0.0001], corrected TIMI frame count (mean difference = -4.63, 95% CI = -8.83 to -0.43, P = 0.03), myocardial blush grade 3 (OR = 2.60, 95% CI = 1.51-4.49, P = 0.0006), and complete ST-segment resolution (OR = 1.64, 95% CI = 1.16-2.33, P = 0.005). After Hartung-Knapp restricted maximum likelihood adjustment, only TIMI grade 3 flow remained significant (OR = 2.38, 95% CI = 1.36-4.15, P = 0.009). No significant differences were observed in major adverse cardiovascular events, bleeding, or thrombocytopenia (P > 0.05). CONCLUSION: During PCI for ACS, intralesional GPI administration improves postprocedural TIMI grade 3 flow, with no significant differences in corrected TIMI frame count, complete ST-segment resolution, or hard clinical outcomes.