Author + information
- Received July 19, 2010
- Revision received October 19, 2010
- Accepted October 28, 2010
- Published online March 8, 2011.
- David E. Winchester, MD⁎,
- Xuerong Wen, MPH†,
- William D. Brearley, MD⁎,
- Ki E. Park, MD⁎,
- R. David Anderson, MD⁎ and
- Anthony A. Bavry, MD, MPH⁎,⁎ ()
- ↵⁎Reprints requests and correspondence:
Dr. Anthony A. Bavry, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, Florida 32610-0277
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.
- glycoprotein IIb/IIIa inhibitors
- percutaneous coronary intervention
- post-procedural myocardial infarction
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.
- Received July 19, 2010.
- Revision received October 19, 2010.
- Accepted October 28, 2010.
- American College of Cardiology Foundation