Abstract 15236: Intracoronary Bolus Administration of Glycoprotein IIb/IIIa Inhibitors is Beneficial During PCI for Acute Coronary Syndromes: a Meta-Analysis of Randomized Trials
Introduction: Studies have shown that glycoprotein IIb/IIIa inhibitors (GPIs) are beneficial as adjunctive therapy during percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). Intracoronary administration of GPI may provide additional benefit; however, prior studies have been underpowered to detect significant differences in clinical endpoints.
Hypothesis: We assessed the hypothesis that intracoronary bolus administration of GPI will improve clinical outcomes.
Methods: We searched the MEDLINE, Cochrane clinical trials, and ClinicalTrials.gov databases for studies of ACS patients undergoing PCI with a GPI. We required that patients were randomized to intracoronary versus intravenous bolus administration of a GPI. Trials were included if stents and thienopyridines were routinely used and clinical outcomes were reported. Outcomes were assessed within 30 days.
Results: Our search yielded 8 studies with 1,356 patients. Baseline patient characteristics were similar, with a median age across the selected studies of 64 years. The median percentage of female patients and diabetics was 24% and 21%, respectively. The incidence of nonfatal myocardial infarction was 1.3% with intracoronary GPI administration versus 3.0% with intravenous administration (RR = 0.50, 95% CI 0.24 to 1.05, p = 0.07). Major bleeding was 3.4% versus 3.9% (RR = 0.90, 95% CI 0.49 to 1.68, p = 0.75), minor bleeding was 8.0% versus 9.0% (RR = 0.93, 95% CI 0.64 to 1.35, p = 0.70), and mortality was 1.6% versus 3.6% (RR = 0.49, 95% CI 0.24 to 1.00, p = 0.05), respectively.
Conclusion: In conclusion, intracoronary delivery of GPI during PCI for ACS appears to be a safe and effective route of administration. Further studies are warranted to determine if a mortality advantage exists.
- © 2011 by American Heart Association, Inc.