Survival benefit with concomitant clopidogrel and glycoprotein IIb/IIIa inhibitor therapy at ad hoc percutaneous coronary intervention

OBJECTIVE: To study clinical outcomes In patients given glycoprotein (GP) IIb/IIIa Inhibitors with concomitant clopidogrel at the time of ad hoc percutaneous coronary Interventions (PCI). PATIENTS AND METHODS: We studied 30-day and long-term outcomes of patients undergoing elective or urgent PCI from March 1, 1998, to December 31, 2006, stratified by administration of GP IIb/IIIa Inhibitors with concomitant clopidogrel treatment at the time of ad hoc PCI. RESULTS: The mean SO age was 66.3 +/- 11.9 years in 5196 patients receiving compared with 67.8 +/- 11.8 years In 4681 patients not receiving a GP IIb/IIIa Inhibitor (P<.001). Overall, 30-day unadjusted mortality was lower In patients who received a GP IIb/IIIa inhibitor (1.0% vs 1.2%; P=.22). Long-term mortality was significantly lower (P<.001) In patients receiving GP IIb/IIIa Inhibitors at the time of PCI. After propensity analysis to adjust for the likelihood of receiving GP IIb/IIIa Inhibitors on the basis of clinical, angiographic, and procedural characteristics, a significant reduction In 30-day mortality with GP IIb/IIIa Inhibitor use was Identified (hazard ratio, 0.66; 95% confidence Interval, 0.36 +/- 0.87; P=.01). Kaplan-Meier analysis (median follow-up, 48 months) revealed a significant Improvement In long-term survival In patients receiving a GP IIb/IIIa Inhibitor at the time of ad hoc PCI that persisted after propensity adjustments (hazard ratio, 0.88; 95% confidence Interval, 0.79-0.98; P=.021). Patients treated with drug-eluting stents showed a significant Improvement In adjusted long-term mortality. CONCLUSION: In patients undergoing elective or urgent ad hoc PCI, coadministration of a GP IIb/IIIa Inhibitor and dual antiplatelet therapy Is associated with reduced risk-adjusted 30-day and long-term mortality.