Division of Cardiology, Department of Medicine, Rosalind Franklin University of Medicine and Sciences, North Chicago, Illinois, USA.
Catheter Cardiovasc Interv. 2013 Aug 1;82(2):171-81. doi: 10.1002/ccd.24653. Epub 2013 Mar 25.
Recent studies have casted a doubt on usefulness of routine glycoprotein IIb/IIIA inhibitors (GPI) in patients, pretreated with aspirin and clopidogrel, undergoing primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI).
We aimed to investigate the effect of relevant factors, particularly thienopyridine pretreatment, on clinical benefit from GPI in randomized controlled trials (RCT).
We searched electronic databases for RCT comparing GPI to control in patients with STEMI undergoing primary PCI. Relevant study covariates and clinical outcomes were extracted. A random effect cumulative and subgroup analyses (thienopyridine non-pretreated studies vs. pretreated studies) were performed. A weighted random effect meta-regression to determine the effect of thienopyridine pretreatment, enrollment year, control group mortality, and ischemic time on mortality benefit from GPI use was conducted.
Twenty studies (9 non-pretreated, 11 pretreated) with a total of 7,414 patients (3,811 GPI, 3,603 control) were included. GPI use reduces mortality (risk ratio, RR = 0.75 95% confidence interval (CI) 0.57-0.97, P = 0.03), target vessel revascularization (TVR) (RR = 0.63, 95% CI 0.50-0.80, P = 0.0002), but not reinfarction (RR = 0.66, 95% CI 0.44-1.0, P = 0.05) at 30 days. There was no effect of thienopyridine pretreatment on reduction in mortality (P = 0.39), reinfarction (P = 0.46), or TVR (P = 0.95) in subgroup analysis. Meta-regression analyses showed significant effect of control group mortality risk (B = -12.15, P = 0.034) but not of thienopyridine pretreatment, enrollment year or control group ischemic time on mortality reduction from GPI use.
The benefit from GPI use in primary PCI for STEMI appears to depend on mortality risk, and not on thienopyridine pretreatment.
最近的研究对在接受阿司匹林和氯吡格雷预处理后行直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中常规使用糖蛋白 IIb/IIIa 抑制剂（GPI）的有效性提出了质疑。
我们旨在研究相关因素，尤其是噻吩吡啶预处理，对随机对照试验（RCT）中 GPI 临床获益的影响。
我们检索了电子数据库，以比较 STEMI 患者行直接 PCI 时 GPI 与对照组的 RCT。提取相关研究协变量和临床结局。进行了随机效应累积和亚组分析（噻吩吡啶未预处理研究与预处理研究）。进行加权随机效应荟萃回归以确定噻吩吡啶预处理、入组年份、对照组死亡率和缺血时间对 GPI 使用的死亡率获益的影响。
共纳入 20 项研究（9 项未预处理，11 项预处理），共 7414 例患者（3811 例 GPI，3603 例对照组）。GPI 的使用降低了死亡率（风险比，RR = 0.75，95%置信区间（CI）0.57-0.97，P = 0.03）、靶血管血运重建（TVR）（RR = 0.63，95%CI 0.50-0.80，P = 0.0002），但对 30 天内的再梗死无影响（RR = 0.66，95%CI 0.44-1.0，P = 0.05）。在亚组分析中，噻吩吡啶预处理对死亡率（P = 0.39）、再梗死（P = 0.46）或 TVR（P = 0.95）的降低均无影响。荟萃回归分析显示，对照组死亡率风险（B = -12.15，P = 0.034）对 GPI 使用降低死亡率有显著影响，但噻吩吡啶预处理、入组年份或对照组缺血时间无影响。
直接 PCI 治疗 STEMI 中 GPI 的获益似乎取决于死亡率风险，而不是噻吩吡啶预处理。
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