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

Study Questions:

What is the efficacy and safety of glycoprotein IIb/IIIa inhibitors (GPIs) during elective percutaneous coronary intervention (PCI) in the contemporary era?

Methods:

The investigators 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:

The 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- 0.79; p < 0.0001). Major bleeding was 1.2% versus 0.9% (RR, 1.37; 95% CI, 0.83-2.25; p = 0.22), minor bleeding was 3.0% versus 1.7% (RR, 1.70; 95% CI, 1.28-2.26; p < 0.0001), and mortality was 0.3% versus 0.5% (RR, 0.70; 95% CI, 0.36-1.33; p = 0.27), respectively.

Conclusions:

The authors concluded that even in the current era of elective PCI performed with stents and thienopyridines, GPIs still provide clinical benefit.

Perspective:

This study suggests that in the current era of elective PCI performed with stents and thienopyridines, GPIs reduce nonfatal myocardial infarction without a notable increase in major bleeding. However, these agents increase minor bleeding and thrombocytopenia. Overall, the study reports that use of GPIs during elective modern PCI appears to be safe and effective. The study findings support the current American College of Cardiology/American Heart Association guidelines where GPI is recommended as a class IIa agent. The role of GPIs will, however, need continued reappraisal as newer and more potent antithrombotics and antiplatelet agents become available.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Incidence, Myocardial Infarction, Platelet Aggregation Inhibitors, Thrombocytopenia, United States, Stents, Percutaneous Coronary Intervention, Platelet Glycoprotein GPIIb-IIIa Complex, Thienopyridines


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