Background-Several platelet glycoprotein (GP) IIb/IIIa receptor antagonists
have been evaluated in clinical trials. We conducted a systematic overview
(meta-analysis) to assess the effect of these compounds on death, myocardi
al infarction (MI), and revascularization.
Methods and Results-ORs were calculated for 16 randomized, controlled trial
s of GP IIb/IIIa inhibitors. An empirical Bayesian random-effects model com
bined the outcomes of 32135 patients. There was a significant mortality red
uction by GP IIb/IIIa inhibitors at 48 to 96 hours, with an OR of 0.70 (95%
CI, 0.51 to 0.96; P<0.03), equivalent to a reduction of 1 death per 1000 p
atients treated. Mortality benefits at 30 days (OR, 0.87; 95% CI, 0.74 to 1
.02; P=0.08) and 6 months (OR, 0.97; 95% CI, 0.86 to 1.10; P=0.67) were not
statistically significant. For the combined end point of death or MI, ther
e was a highly significant (P<0.001) benefit for GP IIb/IIIa inhibitors at
each time point. The 30-day OR was 0.76 (95% CI, 0.66 to 0.87), or 20 fewer
events per 1000 patients treated. For the composite end point of death, MI
, or revascularization, there was also a highly significant (P<0.001) benef
it for GP IIb/IIIa inhibitors. At 30 days, the OR was 0.77 (95% CI, 0.68 to
0.86), or 30 fewer events per 1000 patients treated. The risk differences
for death, death or MI, and composite outcomes were similar at 6 months, in
dicating a sustained absolute improvement. Similar benefit was seen when tr
ials were subgrouped by therapeutic indication (percutaneous intervention v
ersus acute coronary syndromes).
Conclusions-Application of this new therapeutic class to clinical practice
promises substantial benefit for both indications.