title: Glycoprotein IIb/IIIa inhibitors use and outcome after percutaneous coronary intervention for non-ST elevation myocardial infarction.
abstract: OBJECTIVE
  We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12 inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.
  
  
  RESULTS
  This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P = 0.136) or MACE (P = 0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P = 0.021).
  
  
  CONCLUSIONS
  Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Howard
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK ; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK ; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London E2 9JX, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gallagher
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.
authors.forename: K
authors.initials: K
authors.lastname: Rathod
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Antoniou
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.
authors.forename: P
authors.initials: P
authors.lastname: Wright
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK ; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London E2 9JX, UK.
authors.forename: C
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK ; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London E2 9JX, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK ; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK ; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London E2 9JX, UK.
authors.forename: R
authors.initials: R
authors.lastname: Weerackody
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK ; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK ; NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London E2 9JX, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wragg
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D016016:Proportional Hazards Models; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex