Key result
Glycoprotein IIb/IIIa receptor antagonists provided no additional benefit for the composite of death, reinfarction, and stroke in STEMI patients undergoing PCI within 12 hours of fibrinolysis (OR 0.79; 95% CI 0.34-1.83).
Why the study?
Do glycoprotein IIb/IIIa receptor antagonists reduce the composite of death, reinfarction, and stroke in STEMI patients undergoing PCI within 12 hours of fibrinolysis?
Cohort (n=643)
Do glycoprotein IIb/IIIa receptor antagonists reduce the composite of death, reinfarction, and stroke in STEMI patients undergoing PCI within 12 hours of fibrinolysis?
Odds Ratio: 0.79 (95% CI 0.34–1.83)
Absolute Event Rate: 12% vs 13%
p-value: p=0.74
The administration of glycoprotein IIb/IIIa receptor antagonists provided no additional efficacy or safety benefit in STEMI patients undergoing PCI within 12 hours of fibrinolysis.
No benefit seen in this cohort; leaves open glycoprotein IIb/IIIa role after fibrinolysis-facilitated PCI and requires randomized confirmation.
OBJECTIVE: To compare clinical outcomes between glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients who underwent percutaneous coronary intervention (PCI) within 12 hr of fibrinolysis. BACKGROUND: Despite limited evidence, glycoprotein IIb/IIIa receptor antagonists are widely used in ST-elevation myocardial infarction (STEMI) patients undergoing routine early or rescue PCI after fibrinolysis. METHODS: We evaluated 87 and 556 glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients enrolled in a regional registry of STEMI between October 2002 and December 2005. The primary efficacy endpoint was a composite of death from any cause, reinfarction, and stroke at 1 year of follow-up. The primary safety endpoint was the rate of in-hospital major bleeding that was not related to coronary artery bypass grafting. RESULTS: The primary efficacy endpoint occurred in 12% (10 of 81) and 13% (72 of 525) of glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients, respectively (P = 0.74). The corresponding rates of major bleeding during index hospitalization were 4.8% (4 of 84) and 5.1% (28 of 544) (P = 0.88), respectively. Two glycoprotein IIb/IIIa receptor antagonist recipients and five nonrecipients experienced intracranial hemorrhage. After adjusting for propensity score, the odds of primary efficacy (odds ratio, 0.79; 95% confidence interval, 0.34-1.83) and safety (odds ratio, 0.75; 95% confidence interval, 0.22-2.62) endpoints did not differ according to the use of glycoprotein IIb/IIIa receptor antagonists. CONCLUSION: In this observational cohort study of unselected patients with STEMI, the administration of glycoprotein IIb/IIIa receptor antagonists provided no additional benefit to PCI performed within 12 hr of fibrinolysis, nor did it compromise patient safety.
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Belle et al. (2011) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=643). Glycoprotein IIb/IIIa receptor antagonists vs. Nonrecipients was evaluated on Composite of death from any cause, reinfarction, and stroke at 1 year of follow-up (OR 0.79, 95% CI 0.34-1.83, p=0.74). Glycoprotein IIb/IIIa receptor antagonists provided no additional benefit for the composite of death, reinfarction, and stroke in STEMI patients undergoing PCI within 12 hours of fibrinolysis (OR 0.79; 95% CI 0.34-1.83).
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