Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation. An individual patients’ data meta-analysis

Giuseppe De Luca ^1*, Michael Gibson ², Francesco Bellandi ³, Sabina Murphy ², Mauro Maioli ³, Marko Noc ⁴, Uwe Zeymer ⁵, Dariusz Dudek ⁶, Hans-Richard Arntz ⁷, Simona Zorman ⁴, Mesquita Gabriel ⁸, Ayse Emre ⁹, Donald Cutlip ¹⁰, Giuseppe Biondi-Zoccai ¹¹, Tomasz Rakowski ⁶, Mariann Gyongyosi ¹², Paolo Marino ¹³, Kurt Huber ¹⁴ and Arnoud van't Hof ¹⁵

¹ Eastern Piedmont University, Novara, Italy
² TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital, Boston, MA, United States
³ Division of Cardiology, Prato Hospital, Prato, Italy
⁴ Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
⁵ Division of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
⁶ II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
⁷ Medizinische Klinik II, Kardiologie/Pulmologie, Charite, Campus Benjamin Franklin, Berlin, Germany
⁸ Division of Cardiology, Hospital de Santa Maria, Lisboa, Portugal
⁹ Siyami Ersek Thoracic and Cardiovascular Surgery Center, Instabul, Turkey
¹⁰ Interventional Cardiology Section, Beth Israel Deaconess Medical Center, Boston, Massachusets, United States
¹¹ Division of Cardiology, University of Turin, Italy
¹² Department of Cardiology, Medical University of Vienna, Vienna, Austria
¹³ Eastern Piedmont university, Italy
¹⁴ 3rd Department of Medicine (Cardiology and Emergency Medicine) Wilhelminen Hospital, Vienna, Austria
¹⁵ Division of Cardiology, Hospital "De Weezenlanden", Zwolle, Netherlands

^* To whom correspondence should be addressed. E-mail: p.de_luca{at}libero.it.

Accepted 8 April 2008

Abstract

Background Even though time-to-treatment has been shown to be a determinant of mortality in primary angioplasty, still unclear are the potential benefits from early pharmacological reperfusion by glycoprotein (Gp) IIb-IIIa inhibitors. The aim of this meta-analysis was to combine individual data from all randomized 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. We examined all randomized trials on facilitation by early administration of Gp IIb-IIIa inhibitors in STEMI. No language restrictions were enforced. <BR> Individual patients' data were obtained from 11 out of 13 trials, including 1662 patients (840 patients - 50.5% - randomized to early and 822 patients - 49.5% - to late Gp IIb-IIIa inhibitors administration). Preprocedural TIMI 3 flow was more frequent with early Gp IIb-IIIa inhibitors (23.0% vs 13.3%, p < 0.0001). Postprocedural TIMI 3 flow (90% vs 87.9%, p = 0.18) and MBG 3, (49% vs 45.8%, p = 0.18) were higher with early Gp IIb-IIIa inhibitors but did not reach statistical significance, except for abciximab, while the rate of complete ST-segment resolution was significantly higher with early Gp IIb-IIIa inhibitors (60.3% vs 54.1%, p = 0.02). <BR> Mortality was not significantly different between groups (3.7% vs 4.7%, HR [95% CI] = 0.78 [0.49-1.26], p = 0.3), although early abciximab demonstrated improved survival as compared to late administration (2.6% vs 6.5%; HR [95% CI] = 0.39 [0.17-0.9], p = 0.026), even after adjustment for clinical and angiographic confounding factors (p = 0.05).

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