Article Text

other Versions

PDF
Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation. An individual patients’ data meta-analysis
  1. Giuseppe De Luca (p.de_luca{at}libero.it)
  1. Eastern Piedmont University, Novara, Italy
    1. Michael Gibson
    1. TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital, Boston, MA, United States
      1. Francesco Bellandi
      1. Division of Cardiology, Prato Hospital, Prato, Italy
        1. Sabina Murphy
        1. TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital, Boston, MA, United States
          1. Mauro Maioli
          1. Division of Cardiology, Prato Hospital, Prato, Italy
            1. Marko Noc
            1. Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
              1. Uwe Zeymer
              1. Division of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
                1. Dariusz Dudek
                1. II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
                  1. Hans-Richard Arntz
                  1. Medizinische Klinik II, Kardiologie/Pulmologie, Charite, Campus Benjamin Franklin, Berlin, Germany
                    1. Simona Zorman
                    1. Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
                      1. Mesquita Gabriel
                      1. Division of Cardiology, Hospital de Santa Maria, Lisboa, Portugal
                        1. Ayse Emre
                        1. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Instabul, Turkey
                          1. Donald Cutlip
                          1. Interventional Cardiology Section, Beth Israel Deaconess Medical Center, Boston, Massachusets, United States
                            1. Giuseppe Biondi-Zoccai
                            1. Division of Cardiology, University of Turin, Italy
                              1. Tomasz Rakowski
                              1. II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland
                                1. Mariann Gyongyosi
                                1. Department of Cardiology, Medical University of Vienna, Vienna, Austria
                                  1. Paolo Marino
                                  1. Eastern Piedmont university, Italy
                                    1. Kurt Huber
                                    1. 3rd Department of Medicine (Cardiology and Emergency Medicine) Wilhelminen Hospital, Vienna, Austria
                                      1. Arnoud van't Hof
                                      1. Division of Cardiology, Hospital "De Weezenlanden", Zwolle, Netherlands

                                        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.

                                        Statistics from Altmetric.com

                                        Request permissions

                                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.