A comparison of intracoronary with intravenous glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials.

Abstract

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.

• Authors: Gang Fu, Lei Jia, Xin Zhao, Yibo Wang, Xiaohui Chen, Yang Yang, Na Lu, Wei Zhao, Rutai Hui, Yang Zheng
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 25 Issue 3 Pg. 223-34 (Jun 2012) ISSN: 1540-8183 [Electronic] United States
• PMID: 22413751 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: ©2012, Wiley Periodicals, Inc.

Chemical References

• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex

Topics

• Acute Coronary Syndrome (drug therapy, therapy)
• Cardiovascular Diseases
• Coronary Angiography
• Hemorrhage (chemically induced)
• Humans
• Infusions, Intralesional
• Infusions, Intravenous
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (administration & dosage)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Randomized Controlled Trials as Topic
• Ventricular Function, Left