title: Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease.
abstract: BACKGROUND
  Several platelet glycoprotein (GP) IIb/IIIa receptor antagonists have been evaluated in clinical trials. We conducted a systematic overview (meta-analysis) to assess the effect of these compounds on death, myocardial infarction (MI), and revascularization.
  
  
  RESULTS
  ORs were calculated for 16 randomized, controlled trials of GP IIb/IIIa inhibitors. An empirical Bayesian random-effects model combined the outcomes of 32 135 patients. There was a significant mortality reduction by GP IIb/IIIa inhibitors at 48 to 96 hours, with an OR of 0.70 (95% CI, 0. 51 to 0.96; P<0.03), equivalent to a reduction of 1 death per 1000 patients treated. Mortality benefits at 30 days (OR, 0.87; 95% CI, 0. 74 to 1.02; P=0.08) and 6 months (OR, 0.97; 95% CI, 0.86 to 1.10; P=0.67) were not statistically significant. For the combined end point of death or MI, there was a highly significant (P<0.001) benefit for GP IIb/IIIa inhibitors at each time point. The 30-day OR was 0.76 (95% CI, 0.66 to 0.87), or 20 fewer events per 1000 patients treated. For the composite end point of death, MI, or revascularization, there was also a highly significant (P<0.001) benefit for GP IIb/IIIa inhibitors. At 30 days, the OR was 0.77 (95% CI, 0.68 to 0.86), or 30 fewer events per 1000 patients treated. The risk differences for death, death or MI, and composite outcomes were similar at 6 months, indicating a sustained absolute improvement. Similar benefit was seen when trials were subgrouped by therapeutic indication (percutaneous intervention versus acute coronary syndromes).
  
  
  CONCLUSIONS
  Application of this new therapeutic class to clinical practice promises substantial benefit for both indications.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27705, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Kong
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: D P
authors.initials: DP
authors.lastname: Miller
authors.forename: D J
authors.initials: DJ
authors.lastname: Moliterno
authors.forename: H D
authors.initials: HD
authors.lastname: White
authors.forename: R A
authors.initials: RA
authors.lastname: Harrington
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: A M
authors.initials: AM
authors.lastname: Lincoff
authors.forename: V
authors.initials: V
authors.lastname: Hasselblad
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D004311:Double-Blind Method; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex