Background — Clinical trials have demonstrated the benefit of glycoprotein IIb/IIIa inhibitors (GPIs) with stenting in the setting of percutaneous coronary intervention (PCI) in reducing adverse cardiac outcomes.
Objectives — To assess 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 and Methods — Patients who underwent a first PCI at the institution from April 1994 to February 2001 were divided into three cohorts: pre-GPI with selected stent use (P1), selected GPI with routine stent use (P2), and routine GPI with routine stent use (P3). A multiple logistic regression model was constructed to evaluate the different strategy periods, with the rate of in-hospital myocardial infarction, death and abrupt closure as the primary composite end point.
Results — The cohort comprised 7702 patients (2621, 3501 and 1580 patients in P1, P2 and P3, respectively). GPI use increased from 0% in P1 to 17.5% in P2 to 91.0% in P3. There was a significant difference in the unadjusted composite end point among the three periods (4.9%, 3.4% and 2.6%, for P1, P2 and P3, respectively; P<0.001). In the multiple regression analysis, the composite end point was significantly greater in P1 and P2 than in P3 (P1 versus P3, OR 2.61, P<0.0001; P2 versus P3, OR 1.55; P=0.0204).
Conclusions — A significant reduction in adverse in-hospital clinical cardiac events was 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.