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Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors During Elective Coronary Revascularization A meta-analysis of randomized trials performed in the era of stents and thienopyridines Winchester DE, Wen X, Brearley WD, Park KE, Anderson RD, Bavry AA . Disclosures.

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  1. Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors During Elective Coronary RevascularizationA meta-analysis of randomized trials performed in the era of stents and thienopyridinesWinchester DE, Wen X, Brearley WD, Park KE, Anderson RD, Bavry AA

  2. Disclosures • All authors have no conflicts to disclose • This research was supported by an unrestricted grant from the Florida Heart Research Institute

  3. Background and Context • Glycoprotein IIb/IIIa inhibitors (GPI) • Potent antiplatelet agents • Commonly used during percutaneous coronary intervention (PCI) • Contemporary PCI typically performed with: • Stents • Thienopyridines • Aim: To assess efficacy and safety of GPI in contemporary elective PCI • Hypothesis: Benefits of GPI will be minimal and bleeding risks will be elevated

  4. Methods • Meta-analysis of: • MEDLINE, Cochrane, clinicaltrials.gov • Randomized controlled trials of GPI vs. control • DerSimonian-Laird model for risk ratios (RR) • STATA v11 (College Station, TX) • Independent data extraction by two authors (WDB and KEP) • Verification and resolution of disagreements by two authors (DEW and AAB)

  5. Study Selection • 6,377 studies identified by search strategy • MeSH terms and keywords • Limited to humans and clinical trials • 648 studies remained • Abstracts hand searched and non-elective PCI studies were eliminated • 22 studies included in meta-analysis

  6. Outcomes • Periprocedural Myocardial Infarction • Major Bleeding • Minor Bleeding • All-cause mortality

  7. Baseline Characteristics • Mean age = 63 years • Mean percent female = 25% • Median stent use = 98% • Thienopyridine given prior to PCI in 94% (given after PCI in remainder)

  8. Periprocedural Infarction • 5.1% with GPI versus 8.3% with control • RR=0.66 (95% CI 0.55 to 0.79), p<0.0001

  9. Major Bleeding • 1.2% with GPI versus 0.9% with control • RR=1.37 (95% CI 0.83 to 2.25), p=0.22

  10. Minor Bleeding • 3.0% with GPI versus 1.7% with control • RR=1.70 (95% CI 1.28 to 2.26), p<0.0001

  11. Mortality • 0.3% with GPI versus 0.5% with control • RR=0.70 (95% CI 0.36 to 1.33), p=0.27

  12. Metaregression • Influence of various covariates on myocardial infarction • Percentage of patients with diabetes (p = 0.61) • Publication year (p = 0.99) • Thienopyridine before vs after PCI (p = 0.99) • Higher dose of heparin in control arm (p = 0.78)

  13. Limitations • Could not stratify patients by other known risk factors • Platelet reactivity, statin use, lesion complexity • Included ticlopidine studies • However, efficacy is considered similar to clopidogrel

  14. Conclusions • Using GPI during modern elective PCI with thienopyridines and stenting has the following effects: • Postprocedural infarction is significantly reduced, ARR = 3.2%, risk ratio = 0.66 • Major bleeding is not significantly increased • Minor bleeding is significantly increased, ARR = 1.3%, risk ratio = 1.70 • No net effect on mortality Winchester DE, et al JACC 2011

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