Meta-analysis of survival with platelet glycoprotein IIb/IIIa antagonists for percutaneous coronary interventions

被引:71
作者
Kong, DF
Hasselblad, V
Harrington, RA
White, HD
Tcheng, JE
Kandzari, DE
Topol, EJ
Califf, RM
机构
[1] Duke Univ, Clin Res Inst, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Med, Div Cardiol, Durham, NC 27710 USA
[3] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[4] Green Lane Hosp, Auckland 3, New Zealand
关键词
D O I
10.1016/S0002-9149(03)00816-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We performed a cumulative meta-analysis of available studies to evaluate the effect of intravenous platelet glycoprotein (GP) IIb/IIIa antagonists on survival at 30 days and 6 months after percutaneous coronary intervention (PCI). Compounds that block the GP IIb/IIIa receptor substantially reduce myocardial infarctions (MIs) and repeat revascularization. We included 12 trials, which enrolled 20,186 patients in all, in the analysis. Overall, 30-day mortality was significantly reduced with GP IIb/IIIa inhibition (odds ratio 0.73, 95% confidence interval 0.55 to 0.96, p = 0.024). Although 10 of the 12 trials showed a beneficial effect of GP IIb/IIIa inhibitor treatment on mortality, no individual trial detected a statistically significant mortality benefit. The 30-day mortality benefit became significant at the p <0.05 level with addition of the ADMIRAL trial and was further enhanced by the CADILLAC trial. No significant heterogeneity was detected in the collection of trials. At 6 months, the odds ratio was 0.84 (95% confidence interval 0.69 to 1.03, p = 0.087). This survival benefit amounts to preventing similar to 1 of every 3 deaths that occur within 30 days after PCI, saving 2.8 lives/1,000 patients treated (number needed to treat, 357). Thus, patients who undergo PCI can expect significantly lower 30-day mortality, in addition to known reductions in nonfatal MI and repeat procedures, with GP IIb/IIa inhibition. There also is increasing evidence that mortality reductions are preserved at 6 months. (C) 2003 by Excerpta Medica, Inc.
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页码:651 / 655
页数:5
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