Abstract 16740: Intracoronary versus Intravenous Administration of GP IIb/IIIa Inhibitors During Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: It is unclear whether intracoronary (IC) bolus administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of IC and IV administration. Methods and Results: We systematically searched the Cochrane library, EMBASE, and MEDLINE databases for RCTs comparing IC and IV administration of GPIs (abciximab, eptifibatide, tirofiban) during PCI. Data were pooled using random-effects models and stratified into short (1-3 months) and mid/long-term (≥6 months) follow-up durations. Ten RCTs involving 1,590 patients met our inclusion criteria. Seven of the 10 RCTs included only patients with STEMI; in the other 3 studies, the percentage of patients presenting with STEMI ranged from 26% to 63%. Within each study, the dose and duration of GPI administration was identical in the IC and IV groups. Compared to the IV group, the IC group was more likely to have complete perfusion (TIMI 3 flow) post-PCI (relative risk [RR] 1.08, 95% confidence interval [CI] 1.02, 1.15). IC administration was associated with similar bleeding rates as IV (RR 0.91, 95% CI 0.67, 1.24), but with a significant reduction in short-term target vessel revascularization (TVR) (RR 0.55, 95% CI 0.30, 0.99). IC administration was also associated with a significant reduction in short-term mortality (RR 0.49, 95% CI 0.24, 0.99), but this reduction was no longer significant in mid/long term RCTs. Conclusions: Compared to IV, IC bolus administration of GPIs has favorable effects on post-PCI TIMI flow, TVR, and short-term mortality, with similar rates of bleeding. Data regarding mid/long term outcomes were limited and inconclusive. Large RCTs with longer follow-up are required to determine long-term safety and efficacy.