Elsevier

Mayo Clinic Proceedings

Volume 83, Issue 9, September 2008, Pages 995-1001
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Survival Benefit With Concomitant Clopidogrel and Glycoprotein IIb/IIIa Inhibitor Therapy at Ad Hoc Percutaneous Coronary Intervention

https://doi.org/10.4065/83.9.995Get rights and content

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.

Section snippets

PATIENTS AND METHODS

The Mayo Clinic PCI Registry prospectively records demographic, clinical, and angiographic data on all patients who undergo PCI. We reviewed PCI procedures performed between March 1, 1998, and December 31, 2006, a period when our standard of practice included administration of clopidogrel (300 mg) to patients receiving an intracoronary stent. All PCIs were performed in the same setting (ad hoc PCI) as the diagnostic angiography procedure, and patients received dual antiplatelet therapy

RESULTS

At the time of PCI, 12,377 patients received clopidogrel. We excluded 2254 patients with an indication for emergency PCI and 246 who declined research authorization and analyzed the remaining 9877 cases designated as elective or urgent procedures (Table 1). Of these patients, 5196 (53%) received a GP IIb/IIIa inhibitor at the time of the PCI. In 4534 of the 5196 (87%), GP IIb/IIIa was not given until during the procedure; in the remaining 13%, GP IIb/IIIa was given before the procedure.

DISCUSSION

Administration of a GP IIb/IIIa inhibitor and dual antiplatelet therapy (aspirin and clopidogrel) was associated with improved 30-day and long-term mortality in patientsundergoing elective or urgent ad hoc PCI. Long-term adjusted mortality benefit was also seen in patients receiving DESs.

Earlier randomized trials and meta-analyses demonstrated survival advantage and reduction in ischemic complications with the addition of a GP IIb/IIIa inhibitor to aspirin and thienopyridine therapy

CONCLUSION

In patients undergoing elective or urgent ad hoc PCI, adding a GP IIb/IIIa inhibitor to dual antiplatelet therapy at the time of PCI was associated with a significantly improved risk-adjusted 30-day and long-term mortality. Patients with DESs also had lower long-term mortality with GP IIb/IIIa inhibitors given at the time of PCI.

Acknowledgments

We acknowledge the excellent statistical programming support of Joshua P. Slusser.

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