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Effectiveness and safety of glycoprotein IIb/IIIa inhibitors in patients with myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis of observational studies
Authors:Kouz Remi  Kouz Simon  Schampaert Erick  Rinfret Stephane  Tardif Jean-Claude  Nguyen Michel  Eisenberg Mark  Harvey Richard  Afilalo Marc  Lauzon Claude  Dery Jean-Pierre  Mansour Samer  Huynh Thao
Affiliation:
  • a University of Montreal, Canada
  • b Centre Hospitalier Regional de Lanaudiere, Canada
  • c Sacre-Coeur Hospital, Canada
  • d Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Canada
  • e Montreal Heart Institute, Canada
  • f Centre Hospitalier Universitaire de Sherbrooke, Canada
  • g Jewish General Hospital, Canada
  • h Centre Hospitalier de de l'Amiante, Canada
  • i Centre Hospitalier Universitaire de l'Universite de Montreal, Canada
  • j McGill Health University Center, Canada
  • Abstract:

    Introduction

    Meta-analyses of randomized controlled trials (RCT) showed that glycoprotein IIb/IIIa inhibitors (GPI) are associated with reduced adverse events following primary percutaneous coronary revascularization (PCI). However, the external validity of RCTs is generally limited due to their restricted inclusion of patients. The objective of this study is to evaluate the effectiveness and safety of GPI, as adjuvant therapy for primary PCI in real-life patients with myocardial infarction with ST segment elevation (STEMI) from the general population.

    Methods

    We identified all published peer-reviewed observational studies enrolling STEMI patients who underwent primary PCI. We performed random-effect meta-analyses to determine the association of GPI with major adverse events.

    Results

    A total of 11 studies, enrolling 12,253 patients, were retained for this meta-analysis. GPI was associated with approximately 53% reduction in short-term mortality (odds ratio (OR): 0.47, 95% confidence intervals (CI): 0.32-0.68). There was a 62% reduction in long-term mortality associated with GPI (OR: 0.38, 95% CI: 0.30-0.50). GPI was associated with a 62% reduction in 30-day re-infarction (OR: 0.38, 95% CI: 0.24-0.60) and 42% reduction in 30-day repeat PCI (OR: 0.58, 95% CI: 0.36-0.94). A non-significant increase in major bleeding with GPI was observed with an OR of 1.55 (95% CI: 0.92-2.62).

    Conclusions

    GPI is associated with significant reductions in short-term mortality, re-infarction and repeat PCI, long-term mortality and an inconclusive increase in major bleeding. These results provide evidence for the safety and effectiveness of GPI as adjuvant therapy for primary PCI in real-life STEMI patients.
    Keywords:CI, confidence interval   GPI, glycoprotein IIb/IIIa inhibitors   OR, odds ratio   MI, myocardial infarction   PCI, percutaneous coronary intervention   RCT, randomized controlled trials   STEMI, ST segment elevation myocardial infarction
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