PMID- 22961908
OWN - NLM
STAT- MEDLINE
DCOM- 20140220
LR  - 20130723
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 82
IP  - 2
DP  - 2013 Aug 1
TI  - Glycoprotein IIb/IIIa inhibitors with or without thienopyridine pretreatment 
      improve outcomes after primary percutaneous coronary intervention in high-risk 
      patients with ST elevation myocardial infarction--a meta-regression of randomized 
      controlled trials.
PG  - 171-81
LID - 10.1002/ccd.24653 [doi]
AB  - BACKGROUND: 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). OBJECTIVE: We aimed to investigate the 
      effect of relevant factors, particularly thienopyridine pretreatment, on clinical 
      benefit from GPI in randomized controlled trials (RCT). METHODS: 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. RESULTS: 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. CONCLUSION: The benefit from GPI use in primary 
      PCI for STEMI appears to depend on mortality risk, and not on thienopyridine 
      pretreatment.
CI  - (c) 2013 Wiley Periodicals, Inc.
FAU - Sethi, Ankur
AU  - Sethi A
AD  - Division of Cardiology, Department of Medicine, Rosalind Franklin University of 
      Medicine and Sciences, North Chicago, Illinois, USA. drankursethi@gmail.com
FAU - Bajaj, Anurag
AU  - Bajaj A
FAU - Bahekar, Amol
AU  - Bahekar A
FAU - Bhuriya, Rohit
AU  - Bhuriya R
FAU - Singh, Mukesh
AU  - Singh M
FAU - Ahmed, Aziz
AU  - Ahmed A
FAU - Khosla, Sandeep
AU  - Khosla S
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20130325
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Pyridines)
RN  - 0 (thienopyridine)
SB  - IM
CIN - Catheter Cardiovasc Interv. 2013 Aug 1;82(2):182-3. PMID: 23878029
MH  - Chi-Square Distribution
MH  - Drug Therapy, Combination
MH  - Evidence-Based Medicine
MH  - Humans
MH  - Myocardial Infarction/blood/diagnosis/mortality/*therapy
MH  - Odds Ratio
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism
MH  - Pyridines/adverse effects/*therapeutic use
MH  - *Randomized Controlled Trials as Topic
MH  - Recurrence
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2012/09/11 06:00
MHDA- 2014/02/22 06:00
CRDT- 2012/09/11 06:00
PHST- 2012/07/06 00:00 [received]
PHST- 2012/09/01 00:00 [accepted]
PHST- 2012/09/11 06:00 [entrez]
PHST- 2012/09/11 06:00 [pubmed]
PHST- 2014/02/22 06:00 [medline]
AID - 10.1002/ccd.24653 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2013 Aug 1;82(2):171-81. doi: 10.1002/ccd.24653. Epub 
      2013 Mar 25.