Abstract 5763: GP IIb/IIIa Inhibitors During Primary Percutaneous Coronary Intervention for STEMI: A Meta-Analysis of Randomized Controlled Trials
Background: Earlier meta analyses demonstrated a survival benefit with adjunctive GP IIb/IIIa inhibitors (GPI) during primary percutaneous interventions (pPCI) for STEMI. Recent pPCI trials evaluating the role of GPI have demonstrated conflicting results. We performed a comprehensive meta-analysis to evaluate the role of adjuvant GPI therapy in patients undergoing pPCI.
Methods: Our meta-analysis included 15 randomized trials (n= 11407 patients) comparing adjunctive GPI therapy with heparin or bivalirudin in patients undergoing pPCI for STEMI. Summary odds ratios for safety and efficacy endpoints at 30 days were calculated using random-effects models.
Results: There was no significant difference in the incidence of 30-day mortality (Odds ratio [OR] 0.90, 95% CI 0.65–1.23, p = 0.49), reinfarction (OR 0.84, 95% CI 0.61–1.15, p = 0.27) or stroke (OR 0.68, 95% CI 0.35–1.30, p = 0.25). GPI therapy was associated with a significant reduction in rates of target vessel revascularization (OR 0.67, 95% CI 0.53 – 0.85, p = 0.001) and stent thrombosis (OR 0.51, 95% CI 0.32 – 0.83, p = 0.006). The risk of major bleeding (OR 1.72, 95% CI 1.39 –2.14, p< 0.001) and thrombocytopenia (OR 2.2, 95% CI 1.63–2.98, p< 0.001) was significantly increased in the GPI regimen.GPI therapy would prevent approximately 9 ST at the cost of 10 major bleeding episodes for every 1000 STEMI patients.
Conclusion: Adjuvant GPI therapy is not associated with improved survival compared to control therapy in STEMI patients undergoing pPCI. It significantly reduced ST and TVR at the cost of increase in major bleeding and thrombocytopenia.