title: Bolus-only versus bolus + infusion of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention.
abstract: BACKGROUND
  The present study was done to analyze if glycoprotein IIb/IIIa inhibitors (GPI) bolus-only will reduce vascular/bleeding complications and cost with similar major adverse cardiac events (MACE) when compared with GPI bolus + infusion. Evidence-based therapy of GPI inhibitors during percutaneous coronary intervention (PCI) incorporates intravenous bolus followed by 12 to 18 hours of infusion. However, GPI bolus + infusion may increase vascular/bleeding complications and may not reduce MACE when compared with GPI bolus-only.
  
  
  METHODS
  From January 1, 2003, to December 31, 2004, 2,629 consecutive patients received GPI during PCI at a single center. Of these, 1,064 patients received GPI bolus + infusion in 2003 and were compared with 1,565 patients that received GPI bolus-only in 2004. Baseline characteristics were similar in both groups.
  
  
  RESULTS
  Patients receiving GPI bolus-only had reduced vascular/bleeding complications when compared with bolus + infusion (4.9% vs 7%, P < .05, odds ratio 0.62, 95% confidence interval 0.45-0.89). Furthermore, ischemic complications were similar in both groups, including periprocedural creatine kinase-MB enzyme release (12.8% vs 15.3%, P = NS), MACE at 30 days (3.2% vs 3%, P = NS), and death and myocardial infarction at 1 year (7.1% vs 7.8%, P = NS). In addition, GPI bolus-only reduced cost in US dollars ($323 vs $706, P < .001) and increased ambulatory PCI (13.1% vs 3.2%, P < .01), with reduced length of stay (1.1 vs 1.6 days, P < .01), when compared with GPI bolus + infusion.
  
  
  CONCLUSIONS
  Glycoprotein inhibitor bolus-only reduces vascular/bleeding complications with similar MACE and reduced cost when compared with GPI bolus + infusion. In addition, GPI bolus-only improved ambulatory PCI and reduced length of stay. These results are consistent with a safer and cost-effective strategy for bolus-only when GPI therapy is considered during PCI.
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574, USA. samin.sharma@mountsinai.org
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Victor H T
authors.initials: VH
authors.lastname: Chen
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.forename: Paul
authors.initials: P
authors.lastname: Lee
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kim
authors.forename: Angelica
authors.initials: A
authors.lastname: Mares
authors.forename: Javed
authors.initials: J
authors.lastname: Suleman
authors.forename: Pedro R
authors.initials: PR
authors.lastname: Moreno
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma