Randomised controlled trials (RCTs) that evaluated tirofiban, abciximab or eptifibatide were considered for inclusion. Patients scheduled for percutaneous coronary intervention (PCI) with or without acute coronary syndrome, or patients with ST elevated myocardial infarction (STEMI) or non-ST elevated acute coronary syndrome (NSTE-ACS) treated with GIIb/IIIa as the initial medical management were eligible for inclusion. Studies had to compare intravenous tirofiban, abciximab or eptifibatide as a bolus followed by 12 to 96 hours' infusion with abciximab, eptifibatide or placebo in addition to usual care. Usual care included aspirin and ticlopidine or clopidogrel, and heparin or bivalirudin. Studies that included a mix of diagnoses were excluded where separate data were not reported for each population.
The primary outcome was major adverse cardiac event (such as cardiac death, non-fatal myocardial infarction, revascularisation or other composite endpoint). Additional outcomes included all-cause mortality, number of patients with death or non-fatal myocardial infarction, stroke, myocardial infarction, unstable angina, number of patients who underwent PCI and needed urgent revascularisation, and safety outcomes. Outcomes were prespecified. Follow-up points were in-hospital, 30 days and six months.
Diagnoses varied. Studies focused most often on patients with STEMI, followed by NSTE ACS alone or mixed with STEMI patients, and mixed acute and non-acute coronary syndrome. Treatments were most often administered for patients scheduled for PCI. Tirofiban, abciximab or eptifibatide were administered as a bolus followed by infusion. Dosage varied between studies. Three main bolus doses used for tirofiban were high (25μg/mL), medium (10μg/mL) and low (0.4μg/mL). Infusion doses were classed as high (25μg/kg/min), medium (10μg/kg/min) and low (0.4μg/kg/min).
Two reviewers independently selected references for inclusion. Relevant full texts were screened by one reviewer and checked by a second. Disagreements were resolved by consensus or checked by a second reviewer.