Upstream vs Deferred Administration of Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction - Insights From Randomized Clinical Trials

被引:5
作者
Dong, Lili [1 ]
Zhang, Feng [1 ]
Shu, Xianhong [1 ]
机构
[1] Fudan Univ, Shanghai Inst Cardiovasc Dis, Zhongshan Hosp, Shanghai 200032, Peoples R China
关键词
Eptifibatide; Myocardial infarction; Percutaneous coronary intervention; Tirofiban; PRIMARY ANGIOPLASTY; REPERFUSION THERAPY; TIROFIBAN; ABCIXIMAB; METAANALYSIS; BENEFITS; OUTCOMES; QUALITY; FLOW; EPTIFIBATIDE;
D O I
10.1253/circj.CJ-10-0050
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Recent data have demonstrated similar outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) and are treated with small-molecule glycoprotein IIb/IIIa inhibitors (smGPIs) compared with those treated with abciximab. In the present study, a meta-analysis was performed to evaluate the relative safety and efficacy of upstream vs deferred administration of smGPIs in STEMI patients. Methods and Results: A total of 10 randomized clinical trials comparing upstream vs deferred administration of smGPIs in 2,724 patients were located in the electronic databases of the published literature. Preprocedural Thrombolysis In Myocardial Infarction Study (TIMI) grade 2 or 3 flow was present in 45.0% of the upstream group compared with 36.9% in the deferred group (odds ratio (OR) 1.40, P<0.001). However, no difference in post-procedural TIMI 3 flow (OR 0.87, P=0.25) was found between the groups. The 30-day mortality rate in the upstream group did not differ from that of the deferred group (OR 1.04, P=0.85). No significant difference was noted with respect to major bleeding complications (OR 1.25, P=0.38). Conclusions: In STEMI patients scheduled for primary PCI, although early smGPIs treatment improved initial epicardial patency, no beneficial effect on post-procedural angiographic or 30-day clinical outcome was found. Thus, the current available data do not support the routine utilization of upstream smGPIs in STEMI patients treated with primary PCI. (Circ J 2010; 74: 1617-1624)
引用
收藏
页码:1617 / 1624
页数:8
相关论文
共 42 条
[1]   Statistics notes - Concealing treatment allocation in randomised trials [J].
Altman, DG ;
Schulz, KF .
BRITISH MEDICAL JOURNAL, 2001, 323 (7310) :446-447
[2]  
Antman E., 2007, J AM COLL CARDIOL, V2008, P210
[3]   Abciximab-supported infarct artery stent implantation for acute myocardial infarction and long-term survival - A prospective, multicenter, randomized trial comparing infarct artery stenting plus abciximab with stenting alone [J].
Antoniucci, D ;
Migliorini, A ;
Parodi, G ;
Valenti, R ;
Rodriguez, A ;
Hempel, A ;
Memisha, G ;
Santoro, GM .
CIRCULATION, 2004, 109 (14) :1704-1706
[4]   OPERATING CHARACTERISTICS OF A BANK CORRELATION TEST FOR PUBLICATION BIAS [J].
BEGG, CB ;
MAZUMDAR, M .
BIOMETRICS, 1994, 50 (04) :1088-1101
[5]  
BONNEFOY E, 2009, ACC 2009 ORL US MARC
[6]   Effect of tirofiban before primary angioplasty on initial coronary flow and early ST-segment resolution in patients with acute myocardial infarction [J].
Cutlip, DE ;
Ricciardi, MJ ;
Ling, FS ;
Carrozza, JP ;
Dua, V ;
Garringer, J ;
Giri, S ;
Caputo, RP .
AMERICAN JOURNAL OF CARDIOLOGY, 2003, 92 (08) :977-980
[7]   Relationship between patient's risk profile and benefits in mortality from adjunctive abciximab to mechanical revascularization for ST-segment elevation myocardial infarction: A meta-regression analysis of randomized trials [J].
De Luca, G ;
Suryapranata, H ;
Stone, GW ;
Antoniucci, D ;
Tcheng, JE ;
Neumann, FJ ;
Bonizzoni, E ;
Topol, EJ ;
Chiariello, M .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (03) :685-686
[8]   Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction - A meta-analysis of randomized trials [J].
De Luca, G ;
Suryapranata, H ;
Stone, GW ;
Antoniucci, D ;
Tcheng, JE ;
Neumann, FJ ;
Van de Werf, F ;
Antman, EM ;
Topol, EJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 293 (14) :1759-1765
[9]   Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty [J].
De Luca, G ;
Ernst, N ;
Zijlstra, F ;
van't Hof, AWJ ;
Hoorntje, JCA ;
Dambrink, JHE ;
Gosslink, ATM ;
de Boer, MJ ;
Suryapranata, H .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (08) :1363-1367
[10]   Benefits From Small Molecule Administration as Compared With Abciximab Among Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Angioplasty A Meta-Analysis [J].
De Luca, Giuseppe ;
Ucci, Grazia ;
Cassetti, Ettore ;
Marino, Paolo .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (18) :1668-1673