TY - JOUR
T1 - Efficacy and safety of glycoprotein IIb/IIIa inhibitors during elective coronary revascularization
T2 - A meta-analysis of randomized trials performed in the era of stents and thienopyridines
AU - Winchester, David E.
AU - Wen, Xuerong
AU - Brearley, William D.
AU - Park, Ki E.
AU - Anderson, R. David
AU - Bavry, Anthony A.
N1 - Funding Information:
This work was supported by an unrestricted grant from the Florida Heart Research Institute , who had no role in the study design, data collection, analysis, or interpretation, manuscript writing, or decision to proceed with publication. All authors have reported that they have no relationships to disclose.
PY - 2011/3/8
Y1 - 2011/3/8
N2 - Objectives: The purpose of this study was to investigate the efficacy and safety of glycoprotein IIb/IIIa inhibitors (GPIs) during elective percutaneous coronary intervention (PCI). Background: Studies have documented that GPIs are useful during PCI; however, much of this research was conducted before the routine use of coronary stents and thienopyridines. Methods: We searched the MEDLINE, Cochrane clinical trials, and ClinicalTrials.gov databases from inception for studies that randomly assigned patients undergoing elective PCI to a GPI versus control. Trials were included if stents and thienopyridines were used routinely and clinical outcomes were reported. Outcomes were assessed within 30 days. A DerSimonian-Laird model was used to construct random effects summary risk ratios (RRs) and 95% confidence intervals (CIs). Results: Our search yielded 22 studies with 10,123 patients. The incidence of nonfatal myocardial infarction was 5.1% with GPI versus 8.3% with control (RR: 0.66, 95% CI: 0.55 to 0.79, p < 0.0001). Major bleeding was 1.2% versus 0.9% (RR: 1.37, 95% CI: 0.83 to 2.25, p = 0.22), minor bleeding was 3.0% versus 1.7% (RR: 1.70, 95% CI: 1.28 to 2.26, p < 0.0001), and mortality was 0.3% versus 0.5% (RR: 0.70, 95% CI: 0.36 to 1.33, p = 0.27), respectively. Conclusions: In the current era of elective PCI performed with stents and thienopyridines, GPIs provide clinical benefit. These agents reduce nonfatal myocardial infarction without a notable increase in major bleeding; however, they increase the risk of minor bleeding. All-cause mortality is not reduced.
AB - Objectives: The purpose of this study was to investigate the efficacy and safety of glycoprotein IIb/IIIa inhibitors (GPIs) during elective percutaneous coronary intervention (PCI). Background: Studies have documented that GPIs are useful during PCI; however, much of this research was conducted before the routine use of coronary stents and thienopyridines. Methods: We searched the MEDLINE, Cochrane clinical trials, and ClinicalTrials.gov databases from inception for studies that randomly assigned patients undergoing elective PCI to a GPI versus control. Trials were included if stents and thienopyridines were used routinely and clinical outcomes were reported. Outcomes were assessed within 30 days. A DerSimonian-Laird model was used to construct random effects summary risk ratios (RRs) and 95% confidence intervals (CIs). Results: Our search yielded 22 studies with 10,123 patients. The incidence of nonfatal myocardial infarction was 5.1% with GPI versus 8.3% with control (RR: 0.66, 95% CI: 0.55 to 0.79, p < 0.0001). Major bleeding was 1.2% versus 0.9% (RR: 1.37, 95% CI: 0.83 to 2.25, p = 0.22), minor bleeding was 3.0% versus 1.7% (RR: 1.70, 95% CI: 1.28 to 2.26, p < 0.0001), and mortality was 0.3% versus 0.5% (RR: 0.70, 95% CI: 0.36 to 1.33, p = 0.27), respectively. Conclusions: In the current era of elective PCI performed with stents and thienopyridines, GPIs provide clinical benefit. These agents reduce nonfatal myocardial infarction without a notable increase in major bleeding; however, they increase the risk of minor bleeding. All-cause mortality is not reduced.
KW - bleeding
KW - glycoprotein IIb/IIIa inhibitors
KW - meta-analysis
KW - percutaneous coronary intervention
KW - post-procedural myocardial infarction
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U2 - 10.1016/j.jacc.2010.10.030
DO - 10.1016/j.jacc.2010.10.030
M3 - Article
C2 - 21371635
AN - SCOPUS:79952293499
SN - 0735-1097
VL - 57
SP - 1190
EP - 1199
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 10
ER -