A comparison of intracoronary with intravenous glycoprotein iib/iiia inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials
Journal of Interventional Cardiology, 05/01/2012
Evidence Based Medicine
Fu G et al. – Intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) can significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication, but cannot improve clinical outcome compared with IV administration.Methods
- Authors performed a meta–analysis of randomized controlled clinical trials.
- A literature search was conducted for relevant trials.
- Primary end–points were short–term (1–3 months) and mid–/long–term (6/12 months) major adverse cardiovascular events (MACEs) (mortality, reinfarction, target vessel revascularization [TVR]).
- Secondary end–points were thrombolysis in myocardial infarction (TIMI) grade flow, TIMI myocardial perfusion grade (TMPG) flow, left ventricular ejection fraction (LVEF) within 2 weeks, and bleeding complication.
- 12 studies were included in the meta–analysis. IC administration of GPIs did not decrease short–term mortality (OR: 0.71, 95% CI: 0.41–1.23, P = 0.22) and reinfarction rate (OR: 0.76, 95% CI: 0.45–1.29, P = 0.31) compared with IV administration.
- There was a trend toward reduction of short–term TVR rate in IC group compared with IV group but not reaching statistical significance (OR: 0.57, 95% CI: 0.31–1.04, P = 0.07).
- IC administration of GPIs significantly increased TIMI grade 3 flow (OR: 1.48, 95% CI: 1.06–2.06, P = 0.02) and TMPG grade 2–3 flow (OR: 2.63, 95% CI: 1.53–4.51, P = 0.0004) compared with IV administration.
- No significant difference was observed in long–term MACEs rate, LVEF, and bleeding complication between the 2 groups.