Meta-analysis of survival with platelet glycoprotein IIb/IIIa antagonists for percutaneous coronary interventions.
We performed a cumulative meta-analysis of available studies to evaluate the effect of intravenous platelet glycoprotein (GP) IIb/IIIa antagonists on survival at 30 days and 6 months after percutaneous coronary intervention (PCI). Compounds that block the GP IIb/IIIa receptor substantially reduce myocardial infarctions (MIs) and repeat revascularization. We included 12 trials, which enrolled 20,186 patients in all, in the analysis. Overall, 30-day mortality was significantly reduced with GP IIb/IIIa inhibition (odds ratio 0.73, 95% confidence interval 0.55 to 0.96, p = 0.024). Although 10 of the 12 trials showed a beneficial effect of GP IIb/IIIa inhibitor treatment on mortality, no individual trial detected a statistically significant mortality benefit. The 30-day mortality benefit became significant at the p <0.05 level with addition of the ADMIRAL trial and was further enhanced by the CADILLAC trial. No significant heterogeneity was detected in the collection of trials. At 6 months, the odds ratio was 0.84 (95% confidence interval 0.69 to 1.03, p = 0.087). This survival benefit amounts to preventing approximately 1 of every 3 deaths that occur within 30 days after PCI, saving 2.8 lives/1,000 patients treated (number needed to treat, 357). Thus, patients who undergo PCI can expect significantly lower 30-day mortality, in addition to known reductions in nonfatal MI and repeat procedures, with GP IIb/IIa inhibition. There also is increasing evidence that mortality reductions are preserved at 6 months.
Kong
David F
DF
Division of Cardiology, Department of Medicine, Duke University Medical Center and Clinical Research Institute, Durham, NC 27710, USA. kong0008@onyx.dcri.duke.edu
Hasselblad
Vic
V
Harrington
Robert A
RA
White
Harvey D
HD
Tcheng
James E
JE
Kandzari
David E
DE
Topol
Eric J
EJ
Califf
Robert M
RM
D015906:Angioplasty, Balloon, Coronary; D006801:Humans; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D013997:Time Factors
D019039:Platelet Glycoprotein GPIIb-IIIa Complex