Glycoprotein IIb/IIIa inhibitors with or without thienopyridine pretreatment improve outcomes after primary percutaneous coronary intervention in high-risk patients with ST elevation myocardial infarction-a meta-regression of randomized controlled trials

• Published in: Catheterization and cardiovascular interventions 2013-08, Vol.82 (2), p.171-181
• Main Authors: Sethi, Ankur, Bajaj, Anurag, Bahekar, Amol, Bhuriya, Rohit, Singh, Mukesh, Ahmed, Aziz, Khosla, Sandeep
• Format: Article
• Language: English
• Subjects: Chi-Square Distribution; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism; Pyridines - adverse effects; Pyridines - therapeutic use; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.24653

Background Recent studies have casted a doubt on usefulness of routine glycoprotein IIb/IIIA inhibitors (GPI) in patients, pretreated with aspirin and clopidogrel, undergoing primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). Objective We aimed to investigate the effect of relevant factors, particularly thienopyridine pretreatment, on clinical benefit from GPI in randomized controlled trials (RCT). Methods We searched electronic databases for RCT comparing GPI to control in patients with STEMI undergoing primary PCI. Relevant study covariates and clinical outcomes were extracted. A random effect cumulative and subgroup analyses (thienopyridine non‐pretreated studies vs. pretreated studies) were performed. A weighted random effect meta‐regression to determine the effect of thienopyridine pretreatment, enrollment year, control group mortality, and ischemic time on mortality benefit from GPI use was conducted. Results Twenty studies (9 non‐pretreated, 11 pretreated) with a total of 7,414 patients (3,811 GPI, 3,603 control) were included. GPI use reduces mortality (risk ratio, RR = 0.75 95% confidence interval (CI) 0.57–0.97, P = 0.03), target vessel revascularization (TVR) (RR = 0.63, 95% CI 0.50–0.80, P = 0.0002), but not reinfarction (RR = 0.66, 95% CI 0.44–1.0, P = 0.05) at 30 days. There was no effect of thienopyridine pretreatment on reduction in mortality (P = 0.39), reinfarction (P =0.46), or TVR (P =0.95) in subgroup analysis. Meta‐regression analyses showed significant effect of control group mortality risk (B = −12.15, P = 0.034) but not of thienopyridine pretreatment, enrollment year or control group ischemic time on mortality reduction from GPI use. Conclusion The benefit from GPI use in primary PCI for STEMI appears to depend on mortality risk, and not on thienopyridine pretreatment. © 2013 Wiley Periodicals, Inc.