Abstract 3165: A Meta-Analysis Of The Effectiveness And Safety Of Glycoprotein IIb/IIIa Inhibitors For Primary Percutaneous Coronary Intervention In Unselected Patients With St-Segment Elevation Myocardial Infarction
Background: Previous studies showed survival benefit and increased major bleeds with glycoprotein IIb/IIIa inhibitors in patients (pts) undergoing primary percutaneous coronary intervention (PPCI). Unselected pts may have different risk profiles than pts enrolled in clinical trials and may be at increased risks for major bleeds with GPIIb/IIIa inhibitors. We aim to evaluate GPIIb/IIIa inhibitors in a meta-analysis of observational studies of PPCI.
Methods: We completed random-effect meta-analysis of short-term mortality, reinfarction and major bleeds for all observational studies.
Results: There were 17 published observational studies with the majority of studies being published after 1996. The total number of pts was 6,192; 3,248 pts received GPIIb/IIIa inhibitors (80% abciximab). Pts who received GPIIb/IIIa inhibitors were younger (mean age of 62 vs 64 years), less likely to be female (23% vs 28%) and less likely to be diabetics (20% vs 22 %) compared to controls. Pts who received GPIIb/IIIa inhibitors had more anterior STEMI relative to control pts (51% vs 45%). Pts who received GPIIb/IIIa inhibitors had reduced short-term mortality (odds ratio (OR): 0.49, 95% confidence interval (CI): 0.34 – 0.69) (Figure 1⇓), re-infarction (OR: 0.31, 95% CI: 0.13– 0.76). GPIIb/IIIa inhibitors were not associated with a significant increase in major bleeds (OR: 1.11, 95% CI: 0.75–1.60).
Conclusion: Although our results were limited by some selection biases, the observed benefits were present despite more high-risk STEMI (anterior location) among pts who received GpIIb/IIIa inhibitor. We did not observe an increase risk of major bleeds with GpIIb/IIIa inhibitor in these studies.