Glycoprotein IIb/IIIa inhibitors use and outcome after percutaneous coronary intervention for non-ST elevation myocardial infarction.

Abstract

AIMS:

We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12 inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.

METHODS AND RESULTS:

This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P = 0.136) or MACE (P = 0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P = 0.021).

CONCLUSION:

Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.

• Authors: J P Howard, D A Jones, S Gallagher, K Rathod, S Antoniou, P Wright, C Knight, A Mathur, R Weerackody, A Wragg
• Journal: BioMed research international (Biomed Res Int) Vol. 2014 Pg. 643981 ( 2014) ISSN: 2314-6141 [Electronic] United States
• PMID: 24895595 (Publication Type: Journal Article, Observational Study)

Chemical References

• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex

Topics

• Aged
• Electrocardiography
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (drug therapy, mortality, physiopathology)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors, metabolism)
• Proportional Hazards Models
• Time Factors
• Treatment Outcome