title: Efficacy and safety of glycoprotein IIb/IIIa receptor antagonists for patients undergoing percutaneous coronary intervention within twelve hours of fibrinolysis.
abstract: OBJECTIVE
  To compare clinical outcomes between glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients who underwent percutaneous coronary intervention (PCI) within 12 hr of fibrinolysis.
  
  
  BACKGROUND
  Despite limited evidence, glycoprotein IIb/IIIa receptor antagonists are widely used in ST-elevation myocardial infarction (STEMI) patients undergoing routine early or rescue PCI after fibrinolysis.
  
  
  METHODS
  We evaluated 87 and 556 glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients enrolled in a regional registry of STEMI between October 2002 and December 2005. The primary efficacy endpoint was a composite of death from any cause, reinfarction, and stroke at 1 year of follow-up. The primary safety endpoint was the rate of in-hospital major bleeding that was not related to coronary artery bypass grafting.
  
  
  RESULTS
  The primary efficacy endpoint occurred in 12% (10 of 81) and 13% (72 of 525) of glycoprotein IIb/IIIa receptor antagonist recipients and nonrecipients, respectively (P = 0.74). The corresponding rates of major bleeding during index hospitalization were 4.8% (4 of 84) and 5.1% (28 of 544) (P = 0.88), respectively. Two glycoprotein IIb/IIIa receptor antagonist recipients and five nonrecipients experienced intracranial hemorrhage. After adjusting for propensity score, the odds of primary efficacy (odds ratio, 0.79; 95% confidence interval, 0.34-1.83) and safety (odds ratio, 0.75; 95% confidence interval, 0.22-2.62) endpoints did not differ according to the use of glycoprotein IIb/IIIa receptor antagonists.
  
  
  CONCLUSIONS
  In this observational cohort study of unselected patients with STEMI, the administration of glycoprotein IIb/IIIa receptor antagonists provided no additional benefit to PCI performed within 12 hr of fibrinolysis, nor did it compromise patient safety.
authors.affiliation: Department of Cardiology, Annecy General Hospital, France. loic.belle@wanadoo.fr
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Magali
authors.initials: M
authors.lastname: Fourny
authors.forename: Thomas
authors.initials: T
authors.lastname: Reynaud
authors.forename: Laure
authors.initials: L
authors.lastname: Hammer
authors.forename: Gérald
authors.initials: G
authors.lastname: Vanzetto
authors.forename: José
authors.initials: J
authors.lastname: Labarère
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D057216:Propensity Score; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex