Current role of glycoprotein IIb/IIIa receptor inhibitors in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention after pretreatment with loading dose thienopyridines

摘要

Platelet activation and aggregation play a central role in the cascade of events leading to ST-segment elevation myocardial infarction (STEMI), and in the adverse cardiovascular outcomes during and after primary percutaneous coronary intervention (PCI). Therefore, antiplatelet therapy has become an important adjunct in the management of STEMI. Aspirin and thienopyridines are mainstays of acute medical therapy, and current guidelines recommend that a loading dose should be given as early as possible to STEMI patients for whom primary PCI is planned [1,2]. The development of platelet glycoprotein IIb/IIIa antagonists (GPIs) has also been a remarkable achievement in the field of antithrombotic therapy, and previous studies have shown that GPIs reduce major adverse cardiac events in STEMI patients treated with primary PCI [3-6]. However, these pieces of evidence favoring the use of GPIs were largely established in the era before the widespread use of thienopyridine loading. In the setting of routine pretreatment with dual-antiplatelet drugs (aspirin and thienopyridines), the question of whether additional GPIs retain their benefits in primary PCI for STEMI is important, as there are concerns that aggressive antiplatelet regimens may increase bleeding complications and adverse outcomes. We therefore performed this meta-analysis to evaluate whether GPIs provide additional clinical benefit in STEMI patients who are undergoing primary PCI after pretreatment with loading doses of thienopyridines.