Efficacy and safety of early versus late glycoprotein IIb/IIIa inhibitors for PCI

• Published in: International journal of cardiology 2013-01, Vol.162 (3), p.210-219
• Main Authors: Xu, Qiang, Yin, Jian, Si, Liang-yi
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal - administration & dosage; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clopidogrel; Coronary heart disease; Diseases of the cardiovascular system; Glycoprotein IIb/IIIa inhibitors; Heart; Humans; Immunoglobulin Fab Fragments - administration & dosage; Medical sciences; Meta-analysis; Myocardial Infarction - drug therapy; Myocardial Infarction - metabolism; Myocarditis. Cardiomyopathies; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism; Postoperative Hemorrhage - metabolism; Postoperative Hemorrhage - prevention & control; Preoperative Care - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic - methods; ST-segment elevation myocardial infarction; Time Factors; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.06.001

Abstract Background Glycoprotein (Gp) IIb/IIIa inhibitors are beneficial for patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, optimal drug timing remains inconclusive. Therefore, this study was to perform a meta-analysis of the clinical efficiency and safety of early versus late GpIIb/IIIa inhibitors in STEMI patients undergoing PCI. Methods A comprehensive search was to identify randomized trials of early versus late GpIIb/IIIa inhibitors in STEMI patients undergoing PCI. The GpIIb/IIIa inhibitors were abciximab and small-molecular Gp inhibitors (SMGP) namely eptifibatide and tirofiban. The efficacy endpoints included pre-procedural Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, post-procedural TIMI 3 flow, complete ST-segment resolution, left ventricle ejection fraction (LVEF), and mortality. The safety endpoint was the occurrence of major bleeding complications. Results Nineteen trials were included in the meta-analysis, involving 4209 patients (early 2124 versus late 2085). Early GpIIb/IIIa inhibitors significantly improved pre-procedural TIMI 3 flow, while early abciximab, but not SMGP, further enhanced post-procedural TIMI 3 flow, complete ST-segment resolution, LVEF, and reduced six-month mortality. In addition to clopidogrel loading, only early abciximab improved pre-procedural TIMI 3 flow and complete ST-segment resolution. The rate of major bleeding complications was not increased in early GpIIb/IIIa inhibitors with/without clopidogrel loading. Conclusions Early GpIIb/IIIa inhibitors improved pre-procedural TIMI 3 flow and early abciximab provided favorable clinical outcomes in STEMI patients undergoing PCI. On the basis of clopidogrel loading, early abciximab enhanced pre-procedural TIMI 3 flow and ST-segment resolution. These beneficial effects were achieved without increased risks of major bleeding complications.