Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, me
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REVIEW
Open Access
Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression Carolina Saleiro1* , Rogério Teixeira1,2,3, Diana De Campos1, João Lopes1, Bárbara Oliveiros2,3, Marco Costa1 and Lino Gonçalves1,2,3
Abstract Background: Cardiogenic shock complicates 5–10% of myocardial infarction (MI) cases. Data about the benefit of glycoprotein IIb/IIIa inhibitors (GPI) in these patients is sparse and conflicting. Methods: We performed a systematic review, meta-analysis, and meta-regression of studies assessing the impact of GPI use in the setting of MI complicated cardiogenic shock on mortality, angiographic success, and bleeding events. We systematically searched for studies comparing GPI use as adjunctive treatment versus standard care in this setting. Random-effects meta-analysis and meta-regression were performed. Results: Seven studies with a total of 1216 patients (GPI group, 720 patients; standard care group, 496 patients) were included. GPI were associated with a 45% relative reduction in the odds of death at 30 days (pooled OR 0.55; 95% CI 0.35–0.85; I2 = 57%; P = 0.007) and a 49% reduction in the odds of death at 1 year (pooled OR 0.51; 95% CI 0.32–0.82; I2 = 58%; P = 0.005). Reduction in short-term mortality seemed to be more important before 2000, as this benefit disappears if only the more recent studies are analyzed. GPI were associated with a 2-fold increase in the probability of achieving TIMI 3 flow (pooled OR, 2.05; 95% CI 1.37–3.05; I2 = 37%, P = 0.0004). Major bleeding events were not increased with GPI therapy (pooled OR, 1.0; 95% CI 0.55–1.83; I2 = 1%, P = 0.99). Meta-regression identified that patients not receiving an intra-aortic balloon pump seemed to benefit the most from GPI use (Z = − 1.57, P = 0.005). Conclusion: GPI therapy as an adjunct to standard treatment in cardiogenic shock was associated with better outcomes, including both short- and long-term survival, without increasing the risk of bleeding. Keywords: Glycoprotein IIb/IIIa inhibitors, Abciximab, Eptifibatid, Cardiogenic shock
Background Cardiogenic shock complicates 5 to 10% of myocardial infarction (MI) cases [1, 2]. Apart from immediate revascularization, no other treatment has been shown to improve outcomes, and reported intra-hospital mortality * Correspondence: [email protected] 1 Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Quinta dos Vales, 3041-801 Coimbra, Portugal Full list of author information is available at the end of the article
ranges from 23 to 44% [3, 4]. Further, optimal treatment options are still debated. These features underscore the difficulty in conducting trials in this setting. Activation of the platelet glycoprotein IIb/IIIa receptor is the final common pathway in the process leading to platelet aggregation, making glycoprotein IIb/IIIa inhibitors (GPI) the most powerful antiplatelet drugs [5]. Their valuable effects in patients with acute coronary syndrome (ACS) have been s
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