Early administration of small-molecule glycoprotein IIb/IIIa inhibitors before primary percutaneous coronary intervention for ST-elevation myocardial infarction: insights from randomized clinical trials.
BACKGROUND
Current guidelines recommend abciximab (ReoPro) as an adjunctive pharmacologic agent to primary percutaneous coronary intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). However, small-molecule glycoprotein IIb/IIIa receptor inhibitors (smGPIs), such as tirofiban (aggrastat) and eptifibatide (integrilin), are more commonly used in clinical practice.


RESULTS
We performed a meta-analysis to compare the safety and efficacy of early administration of smGPIs versus abciximab before PPCI. The literature was scanned by formal searches of electronic databases from January 1990 to April 2009. A total of 4 randomized trials meeting the prespecified criteria were analyzed, involving 2040 patients. Rates of initial Thrombolysis in Myocardial Infarction Study (TIMI) 3 flow before procedure as well as complete ST resolution after PPCI were not inferior in smGPIs group compared with abciximab group (odds ratio [OR] 1.12, P = .31; and OR 1.05, P = .66, respectively). There was no significant difference in the risk of 30-day (OR 0.83, P = .54) or 8-month mortality (OR 0.78, P = .43) between smGPI and abciximab group. With regard to the safety end points, neither the major nor the minor bleeding complications in smGPIs group differed significantly from those in abciximab group (OR 1.32, P = .43; and OR 0.82, P = .37, respectively).


CONCLUSIONS
This meta-analysis shows that early administration of smGPIs is as effective as abciximab in the setting of PPCI for STEMI, without an increase in bleeding complications.
Dong
Lili
L
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Zhang
Feng
F
Shu
Xianhong
X
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077542:Eptifibatide; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000628:therapy*; D010455:Peptides / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab