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

Gumina RJ, Yang EH, Sandhu GS, Prasad A, Bresnahan JF, Lennon RJ, Rihal CS, Holmes DR, Singh M
Mayo Clin Proc. 2008 83 (9): 995-1001

PMID: 18775199 · DOI:10.4065/83.9.995

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+/-SD 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, 0.56; 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.

MeSH Terms (20)

Aged Angioplasty, Balloon, Coronary Clopidogrel Combined Modality Therapy Confidence Intervals Drug Therapy, Combination Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction Odds Ratio Platelet Aggregation Inhibitors Platelet Glycoprotein GPIIb-IIIa Complex Postoperative Complications Severity of Illness Index Survival Analysis Ticlopidine Treatment Outcome

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