Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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.
Horton H. Glycoprotein IIb/IIIa Inhibition. JAMA. 2004;292(18):2211–2212. doi:10.1001/jama.292.18.2211-a
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: