Abstract 10903: What is the Benefit of Glycoprotein IIb/IIIa Inhibitors During Percutaneous Coronary Intervention? A Meta-Analysis of Randomized Clinical Trials Performed in the Era of Stents and Thienopyridines
Background: Glycoprotein IIb/IIIa inhibitors (GPI) are potent antiplatelet medications that are frequently used during percutaneous coronary intervention (PCI) to reduce thrombotic complications and mortality. The current utility of GPI has become less clear since the advent of thienopyridines and coronary stents.
Methods: We conducted a search of the MEDLINE, Cochrane clinical trials, and clinicaltrials.gov databases for randomized clinical trials comparing GPI to control in PCI patients. Only trials which routinely used thienopyridines and coronary stents were included. Trials that used lytics or GPI more than 6 hours upstream were excluded. Random effects summary risk ratios were constructed using a DerSimonian-Laird model. Metaregression was used to identify sources of heterogeneity.
Results: 39 trials in 22,548 patients were included in our meta-analysis. The primary outcome of 30-day mortality was 1.1% in the GPI group versus 1.4% in the control group (RR = 0.85, 95% confidence interval [CI] 0.67 – 1.09, p value = 0.20). This finding was similar with mortality at 6 to 12 months and held true for each patient population that we examined: ST elevation myocardial infarction (MI) (RR = 0.86, 95% CI 0.62 – 1.20), non ST elevation MI (RR = 0.92, 95% CI 0.60 – 1.39), and stable coronary artery disease (RR = 0.85, 95% CI 0.67 – 1.09). For 30-day mortality, heterogeneity (I2 = 0%) and publication bias (Egger's p = 0.24, Begg's p = 0.84) were not observed. Periprocedural MI was 4.6% with GPI versus 6.4% with control (RR = 0.68, 95% CI 0.57 – 0.81, p < 0.0001); however, publication bias (Egger's p = 0.03) and heterogeneity (I2 = 36%) were observed. Major bleeding was 2.0% with GPI versus 1.3% with control (RR = 1.44, 95% CI 1.11 – 1.88, p = 0.007). Minor bleeding was 5.1% of patients with GPI and 3.1% with control (RR = 1.66, 95% CI 1.44 to 1.91, p < 0<52>0001).
Conclusions: When used in conjunction with thienopyridines and coronary stents during PCI, GPIs do not appear to significantly reduce 30-day or 6 to 12 month mortality. Periprocedural MI may be reduced; however this finding is limited by publication bias and heterogeneity among the studies. Any benefit derived from using GPI may be offset by an increase in major and minor bleeding.
- Glycoprotein iib/iiia platelet inhibitors
- Myocardial infarction
- Percutaneous coronary intervention
- © 2010 by American Heart Association, Inc.