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Glycoprotein IIb/IIIa inhibitors use and outcome after percutaneous coronary intervention for non-ST elevation

J P Howard1, D A Jones2, S Gallagher1

  • 1Department of Cardiology, Barts Health NHS Trust, London E2 9JX, UK.

Biomed Research International
|June 5, 2014
PubMed

Insights

Glycoprotein IIb/IIIa inhibitors did not improve long-term survival or reduce major adverse cardiac events after percutaneous coronary intervention for non-ST elevation myocardial infarction. Use of these agents was linked to increased bleeding risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors were previously associated with improved short-term outcomes post-percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction (NSTEMI).
  • However, prior trials predated routine P2Y12 inhibitor use, and recent data on GP IIb/IIIa inhibitors yield conflicting results.
  • Registry data suggest a potential for increased bleeding risk with GP IIb/IIIa inhibitors compared to trial findings.

Purpose of the Study:

  • To evaluate the long-term impact of GP IIb/IIIa inhibitors on outcomes in patients undergoing PCI for NSTEMI.
  • To assess the association between GP IIb/IIIa inhibitor use and all-cause mortality, major adverse cardiac events (MACE), and bleeding risk.
  • To clarify the role of GP IIb/IIIa inhibitors in the modern era of dual-antiplatelet therapy.

Main Methods:

  • Retrospective observational study of 3047 patients with NSTEMI who underwent PCI and received dual-antiplatelet therapy.
  • Primary outcome: all-cause mortality. Secondary outcomes: MACE and major bleeding.
  • Multivariate analysis, including propensity score matching, was used to adjust for baseline differences.

Main Results:

  • Patients receiving GP IIb/IIIa inhibitors were younger and had fewer comorbidities.
  • Unadjusted analysis suggested improved outcomes with GP IIb/IIIa inhibitors.
  • Multivariate analysis revealed no significant benefit in survival (P = 0.136) or MACE (P = 0.614) and an increased risk of major bleeding (P = 0.021).

Conclusions:

  • GP IIb/IIIa inhibitor use in NSTEMI patients undergoing PCI was not associated with improved long-term survival or reduced MACE after adjusting for confounders.
  • The observed benefits in unadjusted analyses were likely due to favorable baseline characteristics of patients receiving these agents.
  • GP IIb/IIIa inhibitor use was associated with a significantly higher risk of major bleeding.
Abstract

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