Routine use of glycoprotein IIb/IIIa inhibitor therapy is associated with an improved in-hospital outcome after percutaneous coronary intervention: Insights from a large, prospective, single-centre registry.
BACKGROUND
Clinical trials have demonstrated the benefit of glycoprotein IIb/IIIa inhibitors (GPIs) with stenting in the setting of percutaneous coronary intervention (PCI) in reducing adverse cardiac outcomes.


OBJECTIVE
To assess the association between a strategy of routine GPI use and the prevention of adverse cardiac outcomes post-PCI at a large, tertiary care institution.


METHODS
Patients who underwent a first PCI at the institution from April 1994 to February 2001 were divided into three cohorts: pre-GPI with selected stent use (P1), selected GPI with routine stent use (P2), and routine GPI with routine stent use (P3). A multiple logistic regression model was constructed to evaluate the different strategy periods, with the rate of in-hospital myocardial infarction, death and abrupt closure as the primary composite end point.


RESULTS
The cohort comprised 7702 patients (2621, 3501 and 1580 patients in P1, P2 and P3, respectively). GPI use increased from 0% in P1 to 17.5% in P2 to 91.0% in P3. There was a significant difference in the unadjusted composite end point among the three periods (4.9%, 3.4% and 2.6%, for P1, P2 and P3, respectively; P<0.001). In the multiple regression analysis, the composite end point was significantly greater in P1 and P2 than in P3 (P1 versus P3, OR 2.61, P<0.0001; P2 versus P3, OR 1.55; P=0.0204).


CONCLUSIONS
A significant reduction in adverse in-hospital clinical cardiac events was observed in association with the strategy of routine use of GPI therapy and stenting in a large, consecutive PCI cohort after adjusting for potentially confounding patient characteristics.
Jackevicius
Cynthia A
CA
University Health Network, Toronto, Ontario. Cynthia.Jackevicius@uhn.on.ca
Pinto
Ruxandra
R
Daly
Paul
P
Mackie
Karen
K
Dzavik
Vladimir
V
D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D011336:Probability; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex