title: A comparison of intracoronary with intravenous glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndrome: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  It is still debatable whether intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  We performed a meta-analysis of randomized controlled clinical trials. A literature search was conducted for relevant trials. Primary end-points were short-term (1-3 months) and mid-/long-term (6/12 months) major adverse cardiovascular events (MACEs) (mortality, reinfarction, target vessel revascularization [TVR]). Secondary end-points were thrombolysis in myocardial infarction (TIMI) grade flow, TIMI myocardial perfusion grade (TMPG) flow, left ventricular ejection fraction (LVEF) within 2 weeks, and bleeding complication.
  
  
  RESULTS
  Twelve studies were included in the meta-analysis. IC administration of GPIs did not decrease short-term mortality (OR: 0.71, 95% CI: 0.41-1.23, P = 0.22) and reinfarction rate (OR: 0.76, 95% CI: 0.45-1.29, P = 0.31) compared with IV administration. There was a trend toward reduction of short-term TVR rate in IC group compared with IV group but not reaching statistical significance (OR: 0.57, 95% CI: 0.31-1.04, P = 0.07). IC administration of GPIs significantly increased TIMI grade 3 flow (OR: 1.48, 95% CI: 1.06-2.06, P = 0.02) and TMPG grade 2-3 flow (OR: 2.63, 95% CI: 1.53-4.51, P = 0.0004) compared with IV administration. No significant difference was observed in long-term MACEs rate, LVEF, and bleeding complication between the 2 groups.
  
  
  CONCLUSIONS
  IC administration of GPIs in patients with ACS undergoing PCI can significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication, but cannot improve clinical outcome compared with IV administration.
authors.affiliation: Department of Cardiovascular Diseases, Bethune First Hospital of Jilin University, Changchun, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Fu
authors.forename: Lei
authors.initials: L
authors.lastname: Jia
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Yibo
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.forename: Rutai
authors.initials: R
authors.lastname: Hui
authors.forename: Yang
authors.initials: Y
authors.lastname: Zheng
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D002318:Cardiovascular Diseases; D017023:Coronary Angiography; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D036502:Infusions, Intralesional; D007262:Infusions, Intravenous; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D016277:Ventricular Function, Left
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex