Department of Cardiovascular Diseases, Bethune First Hospital of Jilin University, Changchun, China.
J Interv Cardiol. 2012 Jun;25(3):223-34. doi: 10.1111/j.1540-8183.2011.00711.x. Epub 2012 Mar 13.
It is still debatable whether intracoronary (IC) administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
We performed a meta-analysis of randomized controlled clinical trials. A literature search was conducted for relevant trials. Primary end-points were short-term (1-3 months) and mid-/long-term (6/12 months) major adverse cardiovascular events (MACEs) (mortality, reinfarction, target vessel revascularization [TVR]). Secondary end-points were thrombolysis in myocardial infarction (TIMI) grade flow, TIMI myocardial perfusion grade (TMPG) flow, left ventricular ejection fraction (LVEF) within 2 weeks, and bleeding complication.
Twelve studies were included in the meta-analysis. IC administration of GPIs did not decrease short-term mortality (OR: 0.71, 95% CI: 0.41-1.23, P = 0.22) and reinfarction rate (OR: 0.76, 95% CI: 0.45-1.29, P = 0.31) compared with IV administration. There was a trend toward reduction of short-term TVR rate in IC group compared with IV group but not reaching statistical significance (OR: 0.57, 95% CI: 0.31-1.04, P = 0.07). IC administration of GPIs significantly increased TIMI grade 3 flow (OR: 1.48, 95% CI: 1.06-2.06, P = 0.02) and TMPG grade 2-3 flow (OR: 2.63, 95% CI: 1.53-4.51, P = 0.0004) compared with IV administration. No significant difference was observed in long-term MACEs rate, LVEF, and bleeding complication between the 2 groups.
IC administration of GPIs in patients with ACS undergoing PCI can significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication, but cannot improve clinical outcome compared with IV administration.
对于接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者，冠状动脉内（IC）给予糖蛋白 IIb/IIIa 抑制剂（GPI）是否优于静脉内（IV）给予，目前仍存在争议。
我们对随机对照临床试验进行了荟萃分析。对相关试验进行了文献检索。主要终点是短期（1-3 个月）和中期/长期（6/12 个月）主要不良心血管事件（MACE）（死亡率、再梗死、靶血管血运重建[TVR]）。次要终点是心肌梗死溶栓治疗（TIMI）血流分级、TIMI 心肌灌注分级（TMPG）血流分级、2 周内左心室射血分数（LVEF）和出血并发症。
荟萃分析纳入 12 项研究。与 IV 给药相比，IC 给予 GPI 并未降低短期死亡率（OR：0.71，95%CI：0.41-1.23，P = 0.22）和再梗死率（OR：0.76，95%CI：0.45-1.29，P = 0.31）。与 IV 组相比，IC 组短期 TVR 率呈降低趋势，但未达到统计学意义（OR：0.57，95%CI：0.31-1.04，P = 0.07）。与 IV 给药相比，IC 给予 GPI 可显著增加 TIMI 血流分级 3 级（OR：1.48，95%CI：1.06-2.06，P = 0.02）和 TMPG 血流分级 2-3 级（OR：2.63，95%CI：1.53-4.51，P = 0.0004）。两组间长期 MACE 发生率、LVEF 和出血并发症无显著差异。
在接受 PCI 的 ACS 患者中，IC 给予 GPI 可显著增加靶冠状动脉血流和心肌再灌注，而不增加出血并发症的风险，但与 IV 给予相比，不能改善临床结局。
