Appropriate bolus administration of glycoprotein IIb/IIIa inhibitors for patients with acute coronary syndromes undergoing percutaneous coronary intervention: intracoronary or intravenous ? A comprehensive and updated meta-analysis and systematic review

作者：Ali Hassan Sayegh Sadegh^*; Mirhosseini Seyed Jalil; Shahidzadeh Arezoo; Rahimizadeh Elham; Sarrafan Chaharsoughi Zahra; Ghodratipour Zahra; Lotfaliani Mohammad; Rezaeisadrabadi Mohammad; Dehghan Hamid Reza; Bireta Christian; Weymann Alexander; Sabashnikov Anton; Popov Aron Frederik

来源：Kardiologia Polska, 2016, 74(2): 104-118.

DOI：10.5603/KP.a2015.0138

• glycoprotein IIb/IIla receptor inhibitors
• intravenous
• intracoronary
• acute coronary syndrome
• percutaneous coronary intervention

Background and aim: This systematic review with meta-analysis sought to compare the efficacy and safety of intracoronary (IC) vs. intravenous (IV) administration of glycoprotein (GP) IIb/IIla receptor inhibitors on clinical outcomes following percutaneous coronary intervention in patients with acute coronary syndromes (ST-segment elevation myocardial infarction or non-ST-segment-elevation acute coronary syndrome).
Methods: Medline, Embase, Elsevier, and Sciences online databases as well as Google Scholar literature were used to select appropriate studies with randomised controlled design. The primary end-points were mortality and target vessel revascularisation (TVR), whereas the secondary end points were incidence of thrombolysis in myocardial infarction score 3 flow (TIMI 3 flow means complete perfusion in distal coronary artery bed), re-myocardial infarction (re-MI), major bleeding, stent thrombosis left ventricular ejection fraction (LVEF), and heart failure (HF). The literature search of all major databases retrieved 1006 studies. After screening, a total of 18 trials (5812 patients) were identified with reported outcomes.
Results: Pooled analysis showed IC administration of GP IIb/IIla receptor inhibitors can significantly increase LVEF (WMD 4.97; 95% CI 3.34-6.60; p = 0.000) and the incidence of TIMI 3 flow (OR of 0.77; 95% CI 0.64-0.92; p = 0.005), and significantly decrease in incidence of HF (OR of 1.927; 95% CI 1.189-3.124; p = 0.008). Incidences of TVR, re-MI, major bleeding, stent thrombosis, and mortality showed no significant differences between the IC and IV groups.
Conclusions: Overall, the most appropriate route of administration of GP IIb/IIla inhibitors for patients with acute coronary syndromes appeared to be an IC injection that could increase LVEF and TIMI 3 flow and decrease the incidence of HF. Furthermore, the IC administration was not associated with increased adverse event rates when compared to IV injection.

• 出版日期2016