title: Appropriate bolus administration of glycoprotein IIb/IIIa inhibitors for patients with acute coronary syndromes undergoing percutaneous coronary intervention: intracoronary or intravenous? A comprehensive and updated meta-analysis and systematic review.
abstract: This systematic review with meta-analysis sought to compare the efficacy and safety of intracoronary (IC) vs. intravenous (IV) administration of glycoprotein (GP) IIb/IIIa receptor inhibitors on clinical outcomes following per-cutaneous coronary intervention in patients with acute coronary syndromes (ST-segment elevation myocardial infarction or non-ST-segment-elevation acute coronary syndrome).
  
  
  
  Medline, Embase, Elsevier, and Sciences online databases as well as Google Scholar literature were used to select appropriate studies with randomised controlled design. The primary end-points were mortality and target vessel revascularisation (TVR), whereas the secondary end points were incidence of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means complete perfusion in distal coronary artery bed), re-myocardial infarction (re-MI), major bleeding, stent thrombosis left ventricular ejection fraction (LVEF), and heart failure (HF). The literature search of all major databases retrieved 1006 stud-ies. After screening, a total of 18 trials (5812 patients) were identified with reported outcomes.
  
  
  
  Pooled analysis showed IC administration of GP IIb/IIIa receptor inhibitors can significantly increase LVEF (WMD 4.97; 95% CI 3.34-6.60; p = 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI 0.64-0.92; p = 0.005), and significantly decrease in incidence of HF (OR of 1.927; 95% CI 1.189-3.124; p = 0.008). Incidences of TVR, re-MI, major bleeding, stent thrombosis, and mortality showed no significant differences between the IC and IV groups.
  
  
  
  Overall, the most appropriate route of administration of GP IIb/IIIa inhibitors for patients with acute coronary syndromes appeared to be an IC injection that could increase LVEF and TIMI 3 flow and decrease the incidence of HF. Furthermore, the IC administration was not associated with increased adverse event rates when compared to IV injection.
authors.affiliation: Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. s.alihassan.cardiosurg@gmail.com.
authors.forename: Sadeq
authors.initials: S
authors.lastname: Ali-Hasan-Al-Saegh
authors.forename: Seyed Jalil
authors.initials: SJ
authors.lastname: Mirhosseini
authors.forename: Arezoo
authors.initials: A
authors.lastname: Shahidzadeh
authors.forename: Elham
authors.initials: E
authors.lastname: Rahimizadeh
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sarrafan-Chaharsoughi
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ghodratipour
authors.forename: Mohammad
authors.initials: M
authors.lastname: Lotfaliani
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rezaeisadrabadi
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Dehghan
authors.forename: Christian
authors.initials: C
authors.lastname: Bireta
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011184:Postoperative Period; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: acute coronary syndrome; glycoprotein IIb/IIIa receptor inhibitors; intracoronary; intravenous; percutaneous coronary intervention