Efficacy and safety of glycoprotein IIb/IIIa inhibitors during elective coronary revascularization: a meta-analysis of randomized trials performed in the era of stents and thienopyridines.

摘要

OBJECTIVES: The purpose of this study was to investigate the efficacy and safety of glycoprotein IIb/IIIa inhibitors (GPIs) during elective percutaneous coronary intervention (PCI). BACKGROUND: Studies have documented that GPIs are useful during PCI; however, much of this research was conducted before the routine use of coronary stents and thienopyridines. METHODS: We searched the MEDLINE, Cochrane clinical trials, and ClinicalTrials.gov databases from inception for studies that randomly assigned patients undergoing elective PCI to a GPI versus control. Trials were included if stents and thienopyridines were used routinely and clinical outcomes were reported. Outcomes were assessed within 30 days. A DerSimonian-Laird model was used to construct random effects summary risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Our search yielded 22 studies with 10,123 patients. The incidence of nonfatal myocardial infarction was 5.1% with GPI versus 8.3% with control (RR: 0.66, 95% CI: 0.55 to 0.79, p < 0.0001). Major bleeding was 1.2% versus 0.9% (RR: 1.37, 95% CI: 0.83 to 2.25, p = 0.22), minor bleeding was 3.0% versus 1.7% (RR: 1.70, 95% CI: 1.28 to 2.26, p < 0.0001), and mortality was 0.3% versus 0.5% (RR: 0.70, 95% CI: 0.36 to 1.33, p = 0.27), respectively. CONCLUSIONS: In the current era of elective PCI performed with stents and thienopyridines, GPIs provide clinical benefit. These agents reduce nonfatal myocardial infarction without a notable increase in major bleeding; however, they increase the risk of minor bleeding. All-cause mortality is not reduced.