ORIGINAL ARTICLES

Acute coronary syndromes

Early glycoprotein IIb–IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis

G De Luca^1,2, C M Gibson³, F Bellandi⁴, S Murphy³, M Maioli⁴, M Noc⁵, U Zeymer⁶, D Dudek⁷, H-R Arntz⁸, S Zorman⁵, H M Gabriel⁹, A Emre¹⁰, D Cutlip¹¹, G Biondi-Zoccai¹², T Rakowski⁷, M Gyongyosi¹³, P Marino¹, K Huber¹⁴ and A W J van’t Hof¹⁵

¹ Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy
² Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy
³ TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
⁴ Division of Cardiology, Prato Hospital, Prato, Italy
⁵ Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
⁶ Division of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
⁷ II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
⁸ Medizinische Klinik II, Kardiologie/Pulmologie, Charité, Campus Benjamin Franklin, Berlin, Germany
⁹ Division of Cardiology, Hospital de Santa Maria, Lisboa, Portugal
¹⁰ Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
¹¹ Interventional Cardiology Section, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
¹² Division of Cardiology, University of Turin, Turin, Italy
¹³ Department of Cardiology, Medical University of Vienna, Vienna, Austria
¹⁴ 3rd Department of Medicine (Cardiology and Emergency Medicine) Wilhelminen Hospital, Vienna, Austria
¹⁵ Division of Cardiology, Hospital "De Weezenlanden", Zwolle, The Netherlands

Correspondence to:
Dr G De Luca, Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy; giuseppe.deluca{at}maggioreosp.novara.it

Background: Even though time-to-treatment has been shown to be a determinant of mortality in primary angioplasty, the potential benefits from early pharmacological reperfusion by glycoprotein (Gp) IIb–IIIa inhibitors are still unclear. The aim of this meta-analysis was to combine individual data from all randomised trials conducted on facilitated primary angioplasty by the use of early Gp IIb–IIIa inhibitors.

Methods and results: The literature was scanned by formal searches of electronic databases (MEDLINE, EMBASE) from January 1990 to October 2007. All randomised trials on facilitation by the early administration of Gp IIb–IIIa inhibitors in ST-segment elevation myocardial infarction (STEMI) were examined. No language restrictions were enforced. Individual patient data were obtained from 11 out of 13 trials, including 1662 patients (840 patients (50.5%) randomly assigned to early and 822 patients (49.5%) to late Gp IIb–IIIa inhibitor administration). Preprocedural Thrombolysis in Myocardial Infarction Study (TIMI) grade 3 flow was more frequent with early Gp IIb–IIIa inhibitors. Postprocedural TIMI 3 flow and myocardial blush grade 3 were higher with early Gp IIb–IIIa inhibitors but did not reach statistical significance except for abciximab, whereas the rate of complete ST-segment resolution was significantly higher with early Gp IIb–IIIa inhibitors. Mortality was not significantly different between groups, although early abciximab demonstrated improved survival compared with late administration, even after adjustment for clinical and angiographic confounding factors.

Conclusions: This meta-analysis shows that pharmacological facilitation with the early administration of Gp IIb–IIIa inhibitors in patients undergoing primary angioplasty for STEMI is associated with significant benefits in terms of preprocedural epicardial recanalisation and ST-segment resolution, which translated into non-significant mortality benefits except for abciximab.

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