Efficacy and safety of glycoprotein IIb/IIIa inhibitors during elective coronary revascularization: A meta-analysis of randomized trials performed in the era of stents and thienopyridines

David E. Winchester, Xuerong Wen, William D. Brearley, Ki E. Park, R. David Anderson, Anthony A. Bavry

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1190-1199
Number of pages10
JournalJournal of the American College of Cardiology
Volume57
Issue number10
DOIs
StatePublished - Mar 8 2011
Externally publishedYes

Keywords

  • bleeding
  • glycoprotein IIb/IIIa inhibitors
  • meta-analysis
  • percutaneous coronary intervention
  • post-procedural myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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