Effect of glycoprotein IIb/IIIa inhibitors on the individual components of composite endpoints used in clinical trials of unstable angina and non-Q-wave myocardial infarction.
Inhibitors of the platelet glycoprotein (GP) IIb/IIIa receptor complex have recently been approved for the treatment of patients with unstable angina and non-Q-wave myocardial infarction (MI). We performed a meta-analysis to ascertain the effect of these agents on the individual endpoints of death, myocardial infarction, refractory ischemia, and major bleeding after 30 days of follow-up. Five randomized, placebo-controlled trials involving 17,255 patients were identified. The odds ratios for each of the endpoints in each trial were calculated and combined using a fixed-effects model. There was no significant reduction in death (OR, 0.87; 95% CI, 0.73-1.03; P = 0.1), myocardial infarction (OR, 0.91; 95% CI, 0.82-1.004; P = 0.06), or refractory ischemia (OR, 0.92; 95% CI, 0.78-1.1; P = 0.36) in patients treated with GP IIb/IIIa inhibitors. There was a significant increase in major bleeding following treatment with GP IIb/IIIa inhibitors (OR, 1.2; 95% CI, 1.06-1.4; P = 0.005). When used to treat unstable angina and non-Q-wave MI, this new class of agents appears to be associated with minimal clinical benefit and an increase in major bleeding complications.
Brown
D L
DL
Department of Medicine (Cardiovascular Medicine), Albert Einstein College of Medicine, Bronx, New York 10461, USA. dbrown@montefiore.org
Fann
C S
CS
Chang
C J
CJ
D000789:Angina, Unstable / Q000188:drug therapy* / Q000503:physiopathology; D023381:Endpoint Determination; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D019039:Platelet Glycoprotein GPIIb-IIIa Complex