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Glycoprotein IIb/IIIa inhibitors may improve outcomes in patients with STEMI
In patients with STEMI undergoing PCI who are not at increased risk for bleeding, glycoprotein IIb/IIIa inhibitors before a coronary angiogram may improve 30-day rates of mortality and target vessel revascularization.
Trial investigators performed a meta-analysis of randomized controlled trials comparing glycoprotein IIb/IIIa inhibitors (GPI) to control for primary PCI in patients with STEMI, and meta-regression to investigate the effect of mortality risk, thienopyridine pretreatment and year of enrollment on clinical benefit. The meta-analysis examined 20 studies (nine without thienopyridine pretreatment, 11 with pretreatment) comprising 7,414 patients (GPI, n=3,811; control, n=3,603).
At 30 days, GPI reduced mortality (RR=0.75; P=.03); however, the results were not robust to sensitivity analysis, as exclusion of one trial at a time made results statistically insignificant. Also at 30 days, GPI benefited TVR (RR=0.63; P=.0002), but not reinfarction (RR=0.66; P=.05). Thienopyridine pretreatment did not reduce mortality, reinfarction or TVR in subgroup analysis.
Meta-regression analyses suggested significant effect of control group mortality risk (P=.034), but not of thienopyridine pretreatment, enrollment year or control group ischemic time on mortality reduction from GPI use.
“Our analysis suggests that GPI decrease the 30 days TVR and may also reduce mortality,” researchers wrote. “But, we did not find any effect of thienopyridine pretreatment on clinical benefit from GPI use. On the other hand, control group mortality risk appears to predict the benefit from GPI use.”