Intracoronary Glycoprotein IIb/IIIa Inhibitor for Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YIN Qing ^1,2 , ZHANG Zhigang ² , MA Yaping ³ ,  LI Binfei ²

1. The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;2. Department of Anesthesiology, Zhongshan People’s Hospital, Zhongshan 528403, China;3. Hybio Pharmaceutical Co.,Ltd., Shenzhen 518057, China;

Corresponding author：

LI Binfei, Email: lbf8@msn.com

Keywords：

血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂; 急性冠脉综合征; 经皮介入治疗; 冠脉; 静脉; 系统评价; Meta分析; 随机对照试验

DOI：

10.7507/1672-2531.20130189

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Objective 　To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration.
Methods 　Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software.
Results 　10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47).
Conclusion 　Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.

Citation： YIN Qing,ZHANG Zhigang,MA Yaping,LI Binfei. Intracoronary Glycoprotein IIb/IIIa Inhibitor for Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(9): 1102-1109. doi: 10.7507/1672-2531.20130189 Copy

1.	Altay H, Pehlivanoglu S. Editorial: Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: What has changed in the new European Society of Cardiology guideline? Turk Kardiyol Dern Ars, 2012, 40(1): 1-8.
2.	ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2012, 13(3): 171-228.
3.	Fernandez-Ortiz A, Pan M, Alfonso F, et al. Comments on the ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology. Rev Esp Cardiol, 2012, 65(2): 125-130.
4.	Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(23): 2999-3054.
5.	Muller C. New ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Swiss Med Wkly, 2012, 142: w13514.
6.	Mehilli J, Kastrati A, Schulz S, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation, 2009, 119(14): 1933-1940.
7.	Nakagawa Y, Nobuyoshi M, Yamaguchi T, et al. Efficacy of abciximab for patients undergoing balloon angioplasty: data from Japanese evaluation of c7E3 Fab for elective and primary PCI organization in randomized trial (JEPPORT). Circ J, 2009, 73(1): 145-151.
8.	Ndrepepa G, Kastrati A, Mehilli J, et al. One-year clinical outcomes with abciximab vs. placebo in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention after pre-treatment with clopidogrel: results of the ISAR-REACT 2 randomized trial. Eur Heart J, 2008, 29(4): 455-461.
9.	Iversen A, Abildgaard U, Galloe A, et al. Intracoronary compared to intravenous bolus abciximab during primary percutaneous coronary intervention in ST-segment Elevation Myocardial Infarction (STEMI) patients reduces 30-day mortality and target vessel revascularization: a randomized trial. J Interv Cardiol, 2011, 24(2): 105-111.
10.	Eitel I, Friedenberger J, Fuernau G, et al. Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function. The randomised Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI). Clin Res Cardiol, 2011, 100(5): 425-432.
11.	Thiele H, Wohrle J, Hambrecht R, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet, 2012, 379(9819): 923-931.
12.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011].The Cochrane Collaboration, 2008. Available from:www.cochrane-handbook.org.
13.	Thiele H, Schindler K, Friedenberger J, et al. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation, 2008, 118(1): 49-57.
14.	Gu YL, Kampinga MA, Wieringa WG, et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation, 2010, 122(25): 2709-2717.
15.	Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, et al. Intracoronary versus intravenous abciximab administration in patients with ST-elevation myocardial infarction undergoing thrombus aspiration during primary percutaneous coronary intervention--effects on soluble CD40 ligand concentrations. Atherosclerosis, 2009, 206(2): 523-527.
16.	Iversen A Z, Galatius S, Abildgaard U, et al. Intracoronary compared to intravenous abciximab in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention reduces mortality, target vessel revascularization and reinfarction after 1 year. Cardiology, 2011, 120(1): 43-49.
17.	Galache OJ, Sanchez-Rubio J, Calvo I, et al. Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial. Rev Esp Cardiol, 2006, 59(6): 567-574.
18.	Dave RM. Improving outcome of STEMI PCI: Preliminary Results of Crystal AMI trial. [2011-05-28]. Available from: http://www. clinicaltriairesults. org/slides/CRYSTAL_slid-es. PPT.
19.	Wu TG, Zhao Q, Huang WG, et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Circ J, 2008, 72(10): 1605-1609.
20.	杨新春, 张大鹏, 王乐丰, 等. 冠状动脉内应用国产替罗非班对急性ST段抬高心肌梗死急诊介入治疗后心肌灌注和临床预后的影响. 中华心血管病杂志, 2007, 35(6): 517-522.
21.	Deibele AJ, Jennings LK, Tcheng JE, et al. Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial. Circulation, 2010, 121(6): 784-791.
22.	Schneider DJ. Anti-platelet therapy: glycoprotein IIb-IIIa antagonists. Br J Clin Pharmacol, 2011, 72(4): 672-682.
23.	Navarese EP, Kozinski M, Obonska K, et al. Clinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: a meta-analysis of randomized trials. Platelets, 2012, 23(4): 274-281.
24.	Ronner E, Boersma E, Akkerhuis KM, et al. Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein Ⅱb/Ⅲa receptor blocker. Eur Heart J, 2002, 23(3): 239-246.
25.	Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol, 2011, 108(9): 1244-1251.

1. Altay H, Pehlivanoglu S. Editorial: Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: What has changed in the new European Society of Cardiology guideline? Turk Kardiyol Dern Ars, 2012, 40(1): 1-8.
2. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol (Rome), 2012, 13(3): 171-228.
3. Fernandez-Ortiz A, Pan M, Alfonso F, et al. Comments on the ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology. Rev Esp Cardiol, 2012, 65(2): 125-130.
4. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J, 2011, 32(23): 2999-3054.
5. Muller C. New ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Swiss Med Wkly, 2012, 142: w13514.
6. Mehilli J, Kastrati A, Schulz S, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation, 2009, 119(14): 1933-1940.
7. Nakagawa Y, Nobuyoshi M, Yamaguchi T, et al. Efficacy of abciximab for patients undergoing balloon angioplasty: data from Japanese evaluation of c7E3 Fab for elective and primary PCI organization in randomized trial (JEPPORT). Circ J, 2009, 73(1): 145-151.
8. Ndrepepa G, Kastrati A, Mehilli J, et al. One-year clinical outcomes with abciximab vs. placebo in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention after pre-treatment with clopidogrel: results of the ISAR-REACT 2 randomized trial. Eur Heart J, 2008, 29(4): 455-461.
9. Iversen A, Abildgaard U, Galloe A, et al. Intracoronary compared to intravenous bolus abciximab during primary percutaneous coronary intervention in ST-segment Elevation Myocardial Infarction (STEMI) patients reduces 30-day mortality and target vessel revascularization: a randomized trial. J Interv Cardiol, 2011, 24(2): 105-111.
10. Eitel I, Friedenberger J, Fuernau G, et al. Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function. The randomised Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI). Clin Res Cardiol, 2011, 100(5): 425-432.
11. Thiele H, Wohrle J, Hambrecht R, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet, 2012, 379(9819): 923-931.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011].The Cochrane Collaboration, 2008. Available from:www.cochrane-handbook.org.
13. Thiele H, Schindler K, Friedenberger J, et al. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the randomized Leipzig immediate percutaneous coronary intervention abciximab IV versus IC in ST-elevation myocardial infarction trial. Circulation, 2008, 118(1): 49-57.
14. Gu YL, Kampinga MA, Wieringa WG, et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation, 2010, 122(25): 2709-2717.
15. Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, et al. Intracoronary versus intravenous abciximab administration in patients with ST-elevation myocardial infarction undergoing thrombus aspiration during primary percutaneous coronary intervention--effects on soluble CD40 ligand concentrations. Atherosclerosis, 2009, 206(2): 523-527.
16. Iversen A Z, Galatius S, Abildgaard U, et al. Intracoronary compared to intravenous abciximab in patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention reduces mortality, target vessel revascularization and reinfarction after 1 year. Cardiology, 2011, 120(1): 43-49.
17. Galache OJ, Sanchez-Rubio J, Calvo I, et al. Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial. Rev Esp Cardiol, 2006, 59(6): 567-574.
18. Dave RM. Improving outcome of STEMI PCI: Preliminary Results of Crystal AMI trial. [2011-05-28]. Available from: http://www. clinicaltriairesults. org/slides/CRYSTAL_slid-es. PPT.
19. Wu TG, Zhao Q, Huang WG, et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Circ J, 2008, 72(10): 1605-1609.
20. 杨新春, 张大鹏, 王乐丰, 等. 冠状动脉内应用国产替罗非班对急性ST段抬高心肌梗死急诊介入治疗后心肌灌注和临床预后的影响. 中华心血管病杂志, 2007, 35(6): 517-522.
21. Deibele AJ, Jennings LK, Tcheng JE, et al. Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial. Circulation, 2010, 121(6): 784-791.
22. Schneider DJ. Anti-platelet therapy: glycoprotein IIb-IIIa antagonists. Br J Clin Pharmacol, 2011, 72(4): 672-682.
23. Navarese EP, Kozinski M, Obonska K, et al. Clinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: a meta-analysis of randomized trials. Platelets, 2012, 23(4): 274-281.
24. Ronner E, Boersma E, Akkerhuis KM, et al. Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein Ⅱb/Ⅲa receptor blocker. Eur Heart J, 2002, 23(3): 239-246.
25. Friedland S, Eisenberg MJ, Shimony A. Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome. Am J Cardiol, 2011, 108(9): 1244-1251.

Chinese Journal of Evidence-Based Medicine

Intracoronary Glycoprotein IIb/IIIa Inhibitor for Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

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