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Glycoprotein IIb/IIIa inhibitors should make the procedure of percutaneous coronary intervention safer for the patient. So should these agents be administered to every patient undergoing PCI?
Coronary artery stenting and platelet IIb/IIIa receptor antagonists confer complementary benefits on patients undergoing percutaneous coronary intervention (PCI). Glycoprotein (Gp) IIb/IIIa inhibitors make the procedure safer by reducing periprocedural complications such as myocardial infarction, while stenting reduces restenosis rates and the need for further revascularisation procedures.
If Gp IIb/IIIa inhibitors make PCI safer, then should every PCI patient receive a Gp IIb/IIIa inhibitor? It is difficult to argue against this. Studies of Gp IIb/IIIa inhibitors with mandatory PCI have almost invariably shown benefit from active treatment; within these studies, multiple subgroup analyses have generally shown increased benefit in specific subgroups, particularly among diabetics patients and those with raised troponin concentrations. No subgroup analysis, however, has identified a group of patients that is harmed by adjunctive Gp IIb/IIIa inhibitor treatment during PCI.
RISKS VERSUS BENEFITS
The simplistic answer, therefore, to the question as to who should and who should not receive Gp IIb/IIIa inhibitors is that these agents should be given when the potential benefits to the individual patient outweigh the risks. This is likely to apply to the majority of patients undergoing PCI. However, there will be two groups of patients in whom the risks may outweigh the benefits. On the one hand, there will be patients in whom the risk of the procedure is so low that it is unlikely that the addition of a Gp IIb/IIIa inhibitor will confer any additional benefit. This group is likely to comprise non-diabetic patients with stable symptoms undergoing elective PCI in whom the procedure is uncomplicated and does not involve the use of multiple, or very long, stents. This is not a group of patients that has been extensively …
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