Key result
Intracoronary administration of glycoprotein IIb/IIIa inhibitors did not significantly decrease short-term mortality (OR 0.71; 95% CI 0.41-1.23; P=0.22) compared with intravenous administration.
Why the study?
Does intracoronary administration of glycoprotein IIb/IIIa inhibitors improve clinical outcomes compared to intravenous administration in patients with acute coronary syndrome undergoing percutaneous coronary intervention?
Meta-Analysis
Does intracoronary administration of glycoprotein IIb/IIIa inhibitors improve clinical outcomes compared to intravenous administration in patients with acute coronary syndrome undergoing percutaneous coronary intervention?
Odds Ratio: 0.71 (95% CI 0.41–1.23)
p-value: p=0.22
Intracoronary administration of glycoprotein IIb/IIIa inhibitors during PCI for ACS improves coronary flow and myocardial reperfusion but does not translate to improved clinical outcomes compared to intravenous administration.
No short-term mortality benefit with intracoronary versus intravenous glycoprotein IIb/IIIa inhibitors; supports intravenous administration as standard in ACS PCI.
BACKGROUND: It is still debatable whether intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: We performed a meta-analysis of randomized controlled clinical trials. A literature search was conducted for relevant trials. Primary end-points were short-term (1-3 months) and mid-/long-term (6/12 months) major adverse cardiovascular events (MACEs) (mortality, reinfarction, target vessel revascularization [TVR]). Secondary end-points were thrombolysis in myocardial infarction (TIMI) grade flow, TIMI myocardial perfusion grade (TMPG) flow, left ventricular ejection fraction (LVEF) within 2 weeks, and bleeding complication. RESULTS: Twelve studies were included in the meta-analysis. IC administration of GPIs did not decrease short-term mortality (OR: 0.71, 95% CI: 0.41-1.23, P = 0.22) and reinfarction rate (OR: 0.76, 95% CI: 0.45-1.29, P = 0.31) compared with IV administration. There was a trend toward reduction of short-term TVR rate in IC group compared with IV group but not reaching statistical significance (OR: 0.57, 95% CI: 0.31-1.04, P = 0.07). IC administration of GPIs significantly increased TIMI grade 3 flow (OR: 1.48, 95% CI: 1.06-2.06, P = 0.02) and TMPG grade 2-3 flow (OR: 2.63, 95% CI: 1.53-4.51, P = 0.0004) compared with IV administration. No significant difference was observed in long-term MACEs rate, LVEF, and bleeding complication between the 2 groups. CONCLUSION: IC administration of GPIs in patients with ACS undergoing PCI can significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication, but cannot improve clinical outcome compared with IV administration.
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Fu et al. (2012) conducted a meta-analysis in Acute coronary syndrome (ACS). Intracoronary glycoprotein IIb/IIIa inhibitors vs. Intravenous glycoprotein IIb/IIIa inhibitors was evaluated on Short-term mortality (OR 0.71, 95% CI 0.41-1.23, p=0.22). Intracoronary administration of glycoprotein IIb/IIIa inhibitors did not significantly decrease short-term mortality (OR 0.71; 95% CI 0.41-1.23; P=0.22) compared with intravenous administration.
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