title: Survival benefit with concomitant clopidogrel and glycoprotein IIb/IIIa inhibitor therapy at ad hoc percutaneous coronary intervention.
abstract: OBJECTIVE
  To study clinical outcomes in patients given glycoprotein (GP) IIb/IIIa inhibitors with concomitant clopidogrel at the time of ad hoc percutaneous coronary interventions (PCI).
  
  
  METHODS
  We studied 30-day and long-term outcomes of patients undergoing elective or urgent PCI from March 1, 1998, to December 31, 2006, stratified by administration of GP IIb/IIIa inhibitors with concomitant clopidogrel treatment at the time of ad hoc PCI.
  
  
  RESULTS
  The mean+/-SD age was 66.3+/-11.9 years in 5196 patients receiving compared with 67.8+/-11.8 years in 4681 patients not receiving a GP IIb/IIIa inhibitor (P<.001). Overall, 30-day unadjusted mortality was lower in patients who received a GP IIb/IIIa inhibitor (1.0% vs 1.2%; P=.22). Long-term mortality was significantly lower (P<.001) in patients receiving GP IIb/IIIa inhibitors at the time of PCI. After propensity analysis to adjust for the likelihood of receiving GP IIb/IIIa inhibitors on the basis of clinical, angiographic, and procedural characteristics, a significant reduction in 30-day mortality with GP IIb/IIIa inhibitor use was identified (hazard ratio, 0.56; 95% confidence interval, 0.36-0.87; P=.01). Kaplan-Meier analysis (median follow-up, 48 months) revealed a significant improvement in long-term survival in patients receiving a GP IIb/IIIa inhibitor at the time of ad hoc PCI that persisted after propensity adjustments (hazard ratio, 0.88; 95% confidence interval, 0.79-0.98; P=.021). Patients treated with drug-eluting stents showed a significant improvement in adjusted long-term mortality.
  
  
  CONCLUSIONS
  In patients undergoing elective or urgent ad hoc PCI, coadministration of a GP IIb/IIIa inhibitor and dual antiplatelet therapy is associated with reduced risk-adjusted 30-day and long-term mortality.
authors.affiliation: Ohio State University, Columbus, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gumina
authors.forename: Eric H
authors.initials: EH
authors.lastname: Yang
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: John F
authors.initials: JF
authors.lastname: Bresnahan
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000008:administration & dosage* / Q000037:antagonists & inhibitors*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index; D016019:Survival Analysis; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine