Early vs late administration of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction: a meta-analysis.

摘要: ContextGlycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors improve myocardial reperfusion and clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI), but optimal timing administration remains unclear. No systematic reviews have comprehensively examined the effects early vs delayed these agents.ObjectiveTo perform a meta-analysis randomized trials (prior to transfer to catheterization laboratory) vs late (at time PCI) intravenous administration Gp in acute ST-segment elevation myocardial infarction (STEMI).Data SourcesMEDLINE and Cochrane Controlled Trials Register search literature over past 10 years; papers presented at major cardiac conferences; consultation with national international colleagues as well inhibitor drug manufacturers; text journal article bibliographies.Study Selection Data ExtractionWe comparisons between administration at point initial contact (emergency department or ambulance) late administration (catheterization STEMI. Outcome data had be available on both culprit artery patency evaluated by Thrombolysis Myocardial Infarction (TIMI) flow grades admission and mortality. Two authors independently reviewed abstracts complete articles. Six studies met inclusion criteria. Independent extraction was performed by 2 reviewers confirmed by consensus.Data SynthesisThe 6 enrolled 931 STEMI treated with abciximab (3 trials) or tirofiban trials) combination PCI. TIMI grade 3 flow (41.7% [194/465 29.8% [139/466]) 3 (20.3% [84/413] 12.2% [51/418]) were significantly more frequent early group compared group (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.28-2.22; P<.001; OR, 1.85; 95% CI, 1.26-2.71; P<.001, respectively). The early associated 28% reduction of mortality from 4.7% 3.4%, which not significant consistent with similar trends for reinfarction composite ischemic end point.ConclusionsIn trials, Gp IIb/IIIa appeared coronary favorable trends outcomes. These findings are supportive strategy of facilitated Further evaluations adequately powered large trials are awaited confirm benefit this strategy.