Clinical trials have demonstrated the benefit of glycoprotein IIb/IIIa inhibitors (GPI) with stenting in the setting of percutaneous coronary intervention (PCI) in reducing adverse cardiac outcomes. This study assessed the association between a strategy of routine GPI use and the prevention of adverse cardiac outcomes post-PCI at a large tertiary care institution. Patients who underwent a first PCI at the institution from April 1994 to March 2001 were divided into three cohorts: pre-GPI + selected stent use (P1), selected GPI + routine stent use (P2), and routine GPI + routine stent use (P3). A multiple logistic regression model was constructed to evaluate different strategy periods, with the rate of in-hospital myocardial infarction, death or abrupt closure as the primary composite endpoint.
The cohort consisted of 7,702 patients: 2,621 in P1, 3,501 in P2, and 1,580 in P3. GPI use increased from 0% in P1 to 17.5% in P2 and 91.0% in P3. There was a significant difference in the unadjusted composite endpoint between the three periods (4.9% vs. 3.4% vs. 2.6%, respectively for P1, P2, P3; p<0.001). In the multiple regression analysis, the composite endpoint was significantly greater in P1 and P2 as compared to P3 (OR [P1 vs. P3] = 2.61, p<0.0001; OR [P2 vs. P3] = 1.55, p=0.0204).
The study found a significant reduction in adverse in-hospital clinical cardiac events observed in association with the strategy of routine use of GPI therapy and stenting in a large consecutive PCI cohort after adjusting for potentially confounding patient characteristics.
