Upstream Use of Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
Key result
Upstream use of small-molecule GP IIb/IIIa inhibitors in NSTE ACS reduced 30-day death or myocardial infarction (OR 0.89; 95% CI 0.83-0.95) but increased major bleeding risk (OR 1.23).
Why the study?
Does upstream use of small-molecule GP IIb/IIIa inhibitors reduce 30-day death or myocardial infarction in patients with NSTE ACS?
Population
43,674 patients with non-ST-segment elevation acute coronary syndromes pooled from 12 randomized clinical…
Comparison
Upstream small-molecule glycoprotein IIb/IIIa… vs Placebo or upstream placebo with later…
Design
Meta-analysis
Follow-up
30 days
Authors
Discussion
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Implication
Modest ischemic benefit supports selective upstream GP IIb/IIIa use in NSTE ACS; extends prior RCT data with bleeding trade-offs to weigh.
Study Design
Type
Meta-Analysis (n=43,674)
Structured PICO
Does upstream use of small-molecule GP IIb/IIIa inhibitors reduce 30-day death or myocardial infarction in patients with NSTE ACS?
P
Population
43,674 patients with NSTE ACS from 12 randomized clinical trials evaluating upstream small-molecule GP IIb/IIIa inhibitors versus placebo or delayed provisional use, with 30-day outcomes.
I
Intervention
Upstream small-molecule glycoprotein (GP) IIb/IIIa inhibitors (tirofiban, eptifibatide, and lamifiban).
C
Comparator
Placebo or upstream placebo with later provisional use at the time of percutaneous coronary intervention.
O
Outcome
30-day death and 30-day death or myocardial infarction.composite
Main Result
Odds Ratio: 0.89 (95% CI 0.83–0.95)
Upstream use of small-molecule GP IIb/IIIa inhibitors in NSTE ACS provides a modest reduction in ischemic events but increases the risk of major bleeding.
Cite This Study
Tricoci et al. (2011) conducted a meta-analysis in Non-ST-segment elevation acute coronary syndromes (NSTE ACS) (n=43,674). Upstream small-molecule glycoprotein IIb/IIIa inhibitors vs. Placebo or delayed provisional use at percutaneous coronary intervention was evaluated on 30-day death or myocardial infarction (OR 0.89, 95% CI 0.83-0.95). Upstream use of small-molecule GP IIb/IIIa inhibitors in NSTE ACS reduced 30-day death or myocardial infarction (OR 0.89; 95% CI 0.83-0.95) but increased major bleeding risk (OR 1.23).