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.
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