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November 10, 2004

Glycoprotein IIb/IIIa Inhibition

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(18):2211-2212. doi:10.1001/jama.292.18.2211-a

To the Editor: The study by Dr Montalescot and colleagues1 compares the use of intravenous (IV) glycoprotein (Gp) IIb/IIIa inhibitors early vs at the time of percutaneous coronary intervention and concludes that early use may be preferable. A perhaps more important question is whether early IV use is superior, inferior, or equal to procedural intracoronary use of Gp IIb/IIIa inhibitors. Studies have shown improved outcomes with intracoronary use via coronary catheters2-4 and over-the-wire balloon lumens5 compared with IV use at the time of the procedure; in one study, intracoronary use had 50% fewer major adverse cardiac events (death, myocardial infarction, and urgent revascularization).2 Compared with early use, the intracoronary approach has the potential benefit of knowing the anatomy prior to administration and of not giving a potentially toxic and expensive drug to patients who may not undergo percutaneous intervention but instead require cardiac surgery for which the drug is not indicated. I would hope that any future randomized trial studying early use vs IV procedural use of Gp IIb/IIIa inhibitors for acute myocardial infarction would include intracoronary use in a study arm.