Related Experiment Videos
Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions
Evangelia Karvouni1, Demosthenes G Katritsis, John P A Ioannidis
1Department of Cardiology, Athens Euroclinic, Athens, Greece.
Objectives:
We sought to evaluate the impact of intravenous antagonists of the platelet IIb/IIIa receptor on the survival of patients undergoing percutaneous coronary interventions (PCIs).
Background:
Several trials have shown that intravenous antagonists of the platelet glycoprotein (GP) IIb/IIIa receptor reduce the incidence of myocardial infarction (MI) and composite cardiac outcomes (death, MI, or revascularization) in patients undergoing PCI. However, individual studies have not had adequate power to examine differences in mortality.
Methods:
We performed a meta-analysis of 19 randomized, placebo-controlled trials (20 comparisons, n = 20,137). Death was the primary outcome. Secondary outcomes included MI, composite cardiac outcomes, and major bleeding.
Results:
Mortality was significantly reduced at 30 days (risk ratio [RR] 0.69 [95% confidence interval [CI] 0.53 to 0.90]), at six months (RR 0.79 [95% CI 0.64 to 0.97]), and including longer follow-up (RR 0.79 [95% CI 0.66 to 0.94]), with no significant between-study heterogeneity. The relative risk reduction was largely similar in trials of patients with or without acute myocardial infarction (AMI), in trials continuing or discontinuing heparin after the procedure, and in trials using stents or another PCI as the intended primary procedure. Myocardial infarction and composite outcomes were significantly reduced (p < 0.001 for all) at 30 days and six months. Major bleeding was significantly increased only in trials where heparin infusion was continued after the procedure (RR 1.70 [95% CI 1.36 to 2.14]), although there was no excess bleeding when heparin was discontinued (RR 1.02 [95% CI 0.85 to 1.24]).
Conclusions:
In patients undergoing PCI, GP IIb/IIIa receptor antagonists confer a significant and sustained decrease (20% to 30%) in the risk of death.
Insights
Intravenous antagonists of the platelet glycoprotein (GP) IIb/IIIa receptor significantly reduce mortality in patients undergoing percutaneous coronary interventions (PCIs). This finding is sustained long-term, with reduced risks of death, myocardial infarction, and composite cardiac outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Platelet glycoprotein (GP) IIb/IIIa receptor antagonists are used in percutaneous coronary interventions (PCIs).
- Previous trials indicated reduced myocardial infarction (MI) and composite cardiac outcomes, but lacked power for mortality analysis.
Purpose of the Study:
- To evaluate the impact of intravenous GP IIb/IIIa receptor antagonists on patient survival during PCIs.
- To determine the effect on mortality and other cardiac outcomes in a large patient cohort.
Main Methods:
- Meta-analysis of 19 randomized, placebo-controlled trials involving 20,137 patients.
- Primary outcome was death; secondary outcomes included MI, composite cardiac outcomes, and major bleeding.
Main Results:
- Significant mortality reduction observed at 30 days (RR 0.69), six months (RR 0.79), and longer-term follow-up (RR 0.79).
- Myocardial infarction and composite outcomes were significantly reduced (p < 0.001).
- Major bleeding increased only when heparin was continued post-procedure (RR 1.70).
Conclusions:
- Intravenous GP IIb/IIIa receptor antagonists provide a significant and sustained 20%–30% decrease in mortality risk for PCI patients.
- These agents improve survival and reduce adverse cardiac events without increasing bleeding when heparin is discontinued.