Abstract 16740: Intracoronary versus Intravenous Administration of GP IIb/IIIa Inhibitors During Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Meta-Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
Background: It is unclear whether intracoronary (IC) bolus administration of glycoprotein IIb/IIIa inhibitors (GPIs) is superior to intravenous (IV) administration during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of IC and IV administration. Methods and Results: We systematically searched the Cochrane library, EMBASE, and MEDLINE databases for RCTs comparing IC and IV administration of GPIs (abciximab, eptifibatide, tirofiban) during PCI. Data were pooled using random-effects models and stratified into short (1-3 months) and mid/long-term (≥6 months) follow-up durations. Ten RCTs involving 1,590 patients met our inclusion criteria. Seven of the 10 RCTs included only patients with STEMI; in the other 3 studies, the percentage of patients presenting with STEMI ranged from 26% to 63%. Within each study, the dose and duration of GPI administration was identical in the IC and IV groups. Compared to the IV group, the IC group was more likely to have complete perfusion (TIMI 3 flow) post-PCI (relative risk [RR] 1.08, 95% confidence interval [CI] 1.02, 1.15). IC administration was associated with similar bleeding rates as IV (RR 0.91, 95% CI 0.67, 1.24), but with a significant reduction in short-term target vessel revascularization (TVR) (RR 0.55, 95% CI 0.30, 0.99). IC administration was also associated with a significant reduction in short-term mortality (RR 0.49, 95% CI 0.24, 0.99), but this reduction was no longer significant in mid/long term RCTs. Conclusions: Compared to IV, IC bolus administration of GPIs has favorable effects on post-PCI TIMI flow, TVR, and short-term mortality, with similar rates of bleeding. Data regarding mid/long term outcomes were limited and inconclusive. Large RCTs with longer follow-up are required to determine long-term safety and efficacy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.054 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.026 | 0.061 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".