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Intracoronary versus intravenous glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention in patients with STEMI: a systematic review and meta-analysis
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- Authors
- Issue Date
- 2023-07-14
- Publisher
- BMC
- Citation
- Thrombosis Journal Vol.21(1):76
- Keywords
- s ST-elevation myocardial infarction ; Percutaneous coronary intervention ; Glycoprotein IIb/IIIa inhibitor ; Intracoronary administration
- Abstract
- Background Intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) has been studied as an
adjunctive therapy to improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI)
undergoing percutaneous coronary intervention. In this systematic review and meta-analysis, we aimed to evaluate
the efficacy and safety of IC administration of GPIs compared with those of intravenous (IV) administration in patients
with STEMI.
Methods We searched the MEDLINE, Embase, and Cochrane CENTRAL databases for relevant studies published
before September 21, 2022. In total, 22 randomized controlled trials involving 7,699 patients were included.
Results The proportions of patients achieving thrombolysis in myocardial infarction grade 3 flow, myocardial blush
grade 2/3, and complete ST-segment resolution were significantly higher in the IC group than in the IV group.
Major adverse cardiac events (MACE) (RR: 0.54, 95% CI: 0.37–0.80) and heart failure (RR: 0.48, 95% CI: 0.25–0.91)
within 1 month were significantly lower in the IC group than in the IV group; however, after 6 months, no difference
was observed in MACE risk. Additionally, the risks of death and bleeding did not differ between the two routes of
administration.
Conclusions When considering adjunctive GPI administration for patients with STEMI, the IC route may offer greater
benefits than the IV route in terms of myocardial reperfusion and reduced occurrence of MACE and heart failure
within 1 month. Nonetheless, when making decisions for IC administration of GPIs, the absence of a benefit for
bleeding risk and difficulty accessing the administration route should be considered
- ISSN
- 1477-9560
- Language
- English
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