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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 catheters^2-4 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 . . . [Full Text of this Article]

Heather Horton, MD, PhD
hlhorton@geisinger.edu
Geisinger Wyoming Valley Heart Hospital
Wilkes-Barre, Pa

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