Key result
Intracoronary GP IIb/IIIa inhibitors showed no significant difference in mortality or TVR compared to intravenous, but increased LVEF.
Why the study?
Does intracoronary administration of GP IIb/IIIa inhibitors improve clinical outcomes compared to intravenous administration in patients with acute coronary syndromes undergoing PCI?
Meta-Analysis (n=5,812)
Does intracoronary administration of GP IIb/IIIa inhibitors improve clinical outcomes compared to intravenous administration in patients with acute coronary syndromes undergoing PCI?
Answers are grounded in this paper and cite their sources.
Intracoronary administration of GP IIb/IIIa inhibitors in ACS patients undergoing PCI improves LVEF and TIMI 3 flow and reduces heart failure incidence compared to intravenous administration, without increasing adverse events.
BACKGROUND AND AIM: This systematic review with meta-analysis sought to compare the efficacy and safety of intracoronary (IC) vs. intravenous (IV) administration of glycoprotein (GP) IIb/IIIa receptor inhibitors on clinical outcomes following per-cutaneous coronary intervention in patients with acute coronary syndromes (ST-segment elevation myocardial infarction or non-ST-segment-elevation acute coronary syndrome). METHODS: Medline, Embase, Elsevier, and Sciences online databases as well as Google Scholar literature were used to select appropriate studies with randomised controlled design. The primary end-points were mortality and target vessel revascularisation (TVR), whereas the secondary end points were incidence of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means complete perfusion in distal coronary artery bed), re-myocardial infarction (re-MI), major bleeding, stent thrombosis left ventricular ejection fraction (LVEF), and heart failure (HF). The literature search of all major databases retrieved 1006 stud-ies. After screening, a total of 18 trials (5812 patients) were identified with reported outcomes. RESULTS: Pooled analysis showed IC administration of GP IIb/IIIa receptor inhibitors can significantly increase LVEF (WMD 4.97; 95% CI 3.34-6.60; p = 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI 0.64-0.92; p = 0.005), and significantly decrease in incidence of HF (OR of 1.927; 95% CI 1.189-3.124; p = 0.008). Incidences of TVR, re-MI, major bleeding, stent thrombosis, and mortality showed no significant differences between the IC and IV groups. CONCLUSIONS: Overall, the most appropriate route of administration of GP IIb/IIIa inhibitors for patients with acute coronary syndromes appeared to be an IC injection that could increase LVEF and TIMI 3 flow and decrease the incidence of HF. Furthermore, the IC administration was not associated with increased adverse event rates when compared to IV injection.
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Ali‐Hasan‐Al‐Saegh et al. (2015) conducted a meta-analysis in acute coronary syndromes (n=5,812). Intracoronary administration of glycoprotein IIb/IIIa receptor inhibitors vs. Intravenous administration of glycoprotein IIb/IIIa receptor inhibitors was evaluated on mortality and target vessel revascularisation (TVR). Intracoronary GP IIb/IIIa inhibitors showed no significant difference in mortality or TVR compared to intravenous, but increased LVEF.
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