Abstract 4750: Early Administration of Small Molecule Glycoprotein IIb/IIIa Inhibitors in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Insights From Randomized Clinical Trials
Backgrounds: The benefits of early administration of small-molecule glycoprotein IIb/IIIa receptor inhibitors (smGPI), such as tirofiban and eptifibatide in patients undergoing primary percutaneous intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are still a matter of debate.
Methods and Results: We performed a meta-analysis of all available randomized trials to compare the clinical safety and efficacy of early administration of smGPIs versus abciximab as adjunctive therapy to primary angioplasty for STEMI. The literature was scanned by formal searches of electronic databases such as PubMed and conference proceedings from January 1990 to December 2008. Four trials meeting the prespecified criteria were analyzed, involving 2040 patients (1036 in smGPIs group, 1004 in abciximab group). Rates of initial TIMI 3 flow before procedure (22.2% vs. 20.1%) as well as complete ST resolution after PPCI (68.3% vs. 67.9%) were not inferior in smGPIs group compared with abciximab group (odds ratio [OR] 1.12, 95% confidence interval [CI] 0.90 to 1.39, P=0.31; and OR 1.05, 95% CI 0.86 to 1.28, P=0.66, respectively). And there was no significant difference in the risk of 30-day (2.0% vs. 2.3%, OR 0.83, 95% CI 0.46 to 1.51, P=0.54) or 8-month mortality (3.9% vs. 5.0%, OR 0.78, 95% CI 0.41 to 1.46, P=0.43) between smGPI and abciximab group. With regard to the safety endpoints, neither the major (1.7% vs. 1.3%) nor the minor bleeding complications (3.8% vs. 4.8%) in smGPIs group differed significantly from those in abciximab group (OR 1.32, 95% CI 0.66 to 2.62, P=0.43; and OR 0.82, 95% CI 0.53 to 1.27, P=0.37, respectively).
Conclusions This meta-analysis shows that early administration of smGPIs is as effective as abciximab in the setting of PPCI for STEMI without an increase in bleeding risk. Longer follow-up data will certainly provide important additional information.