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

• Published in: Heart (British Cardiac Society) Vol. 94; no. 12; pp. 1548 - 1558
• Main Authors: De Luca, G, Gibson, C M, Bellandi, F, Murphy, S, Maioli, M, Noc, M, Zeymer, U, Dudek, D, Arntz, H-R, Zorman, S, Gabriel, H M, Emre, A, Cutlip, D, Biondi-Zoccai, G, Rakowski, T, Gyongyosi, M, Marino, P, Huber, K, van’t Hof, A W J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.12.2008; BMJ; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Acute Coronary Syndromes; Aged; Angioplasty; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cooperation; Coronary Angiography; Coronary Circulation - physiology; Creatine Kinase - metabolism; Data analysis; Diseases of the cardiovascular system; Drug dosages; Embolism - prevention & control; Emergency Treatment; Female; Heart attacks; Humans; Male; Medical sciences; Meta-analysis; Middle Aged; Mortality; Myocardial Infarction - enzymology; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization - methods; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Regression analysis; Africa; Egypt; Human; Data analysis; Angioplasty; Glycoprotein IIb; Instrumentation therapy; Instrumental dilatation; Glycoprotein IIIa; Metaanalysis; Cooperation; Individual; Primary; Early; Circulatory system; Cardiology; Fibrinolytic
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2008.141648

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.