title: Benefits of pharmacological facilitation with glycoprotein IIb-IIIa inhibitors in diabetic patients undergoing primary angioplasty for STEMI. A subanalysis of the EGYPT cooperation.
abstract: The Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation aimed at evaluating, by pooling individual patient's data of randomized trials, the benefits of pharmacological facilitation with Gp IIb-IIIa inhibitors among STEMI patients undergoing primary angioplasty. In the current study we analyze the benefits of early Gp IIb-IIIa inhibitors in diabetic patients. 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. Individual patients' data were obtained from 11 out of 13 trials, including 1,662 patients. Diabetes was present in 281 (16.9%). Early Gp IIb-IIIa inhibitors were associated with improved preprocedural TIMI 3 flow (26.0% vs. 13.1%, P = 0.006), postprocedural TIMI 3 flow (90.1% vs. 75.0%, P = 0.18), MBG 3 (40.8% vs. 30.4%, P = 0.004), and less distal embolization (11.6% vs. 20.8%, P = 0.05). However, early Gp IIb-IIIa inhibitors did not significantly reduce mortality (8.3% vs. 9.5%, P = 0.64). This meta-analysis shows that pharmacological facilitation with early administration of Gp IIb-IIIa inhibitors in STEMI patients with diabetes undergoing primary angioplasty, is associated with significant benefits in terms of preprocedural and postprocedural TIMI flow, improved myocardial perfusion, without significant benefits in mortality.
authors.affiliation: Division of Cardiology Maggiore della Carità, Hospital, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: C
authors.initials: C
authors.lastname: Michael Gibson
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.forename: Sabina
authors.initials: S
authors.lastname: Murphy
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Hans-Richard
authors.initials: HR
authors.lastname: Arntz
authors.forename: Simona
authors.initials: S
authors.lastname: Zorman
authors.forename: H Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.forename: Ayse
authors.initials: A
authors.lastname: Emre
authors.forename: Donald
authors.initials: D
authors.lastname: Cutlip
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Mariann
authors.initials: M
authors.lastname: Gyongyosi
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: Van't Hof
mesh_terms: D017130:Angioplasty; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex