title: Impact of time from symptom onset to drug administration on outcome in patients undergoing glycoprotein IIb-IIIa facilitated primary angioplasty (from the EGYPT cooperation).
abstract: Contrasting data have been so far reported on facilitation with glycoprotein IIb-IIIa inhibitors (GpIIbIIIa) in patients who underwent primary percutaneous coronary intervention. However, it has been demonstrated a time-dependent composition of coronary thrombus in ST-segment elevation myocardial infarction, with more platelets in the first hours. Subsequently, the benefits of early administration of GpIIbIIIa may be affected by the time from symptoms onset to GpIIbIIIa, that therefore is the aim of this study. Our population is represented by 814 patients who underwent GpIIbIIIa facilitated primary angioplasty included in the Early glycoprotein IIb-IIIa inhibitors in primary angioplasty database. Patients were divided according to quartiles of time from symptom onset to GpIIbIIIa administration (≤65 minutes; 65 to 100 minutes; 101 to 178 minutes; and >178 minutes). Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Time from symptoms onset to GpIIbIIIa was linearly associated with hypertension, diabetes, hypercholesterolemia, and previous myocardial infarction but inversely associated with smoking. Abciximab was more often administrated later from symptoms onset. Time from symptoms onset to GpIIbIIIa was significantly associated with the rate of preprocedural recanalization (thrombolysis in myocardial infarction [TIMI] 2 to 3; p <0.001), postprocedural TIMI 3 flow (p <0.001), the rate of complete ST-segment resolution (p <0.001), and the rate of myocardial blush grade 2 to 3 (p <0.001) and inversely associated with the occurrence of distal embolization (p <0.001). Follow-up data were collected at a median (twenty-fifth to seventy-fifth) of 360 (30 to 1,095) days. A total of 52 patients had died. Time to GpIIbIIIa had a significant impact on mortality (hazard ratio [95% confidence interval] 1.46 [1.11 to 1.92], p = 0.007) that was confirmed after correction for baseline confounding factors (adjusted hazard ratio [95% confidence interval] 1.41 [1.02 to 2.21], p = 0.042). In conclusion, this study showed that in patients who underwent primary angioplasty with upstream GpIIbIIIa, time from symptoms onset to GpIIbIIIa strongly impacts on preprocedural recanalization, distal embolization, myocardial perfusion, and long-term survival.
authors: Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it.
authors: Giuseppe
authors: G
authors: De Luca
authors: Division of Cardiology, Hospital "De Weezenlanden", Zwolle, The Netherlands.
authors: Arnoud W J
authors: AW
authors: Van't Hof
authors: TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors: C Michael
authors: CM
authors: Gibson
authors: Interventional Cardiology Section, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Donald
authors: D
authors: Cutlip
authors: Division of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany.
authors: Uwe
authors: U
authors: Zeymer
authors: Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia.
authors: Marko
authors: M
authors: Noc
authors: Prato Hospital, Prato, Italy.
authors: Mauro
authors: M
authors: Maioli
authors: Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia.
authors: Simona
authors: S
authors: Zorman
authors: Division of Cardiology, Hospital de Santa Maria, Lisboa, Portugal.
authors: H Mesquita
authors: HM
authors: Gabriel
authors: Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors: Ayse
authors: A
authors: Emre
authors: II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Tomasz
authors: T
authors: Rakowski
authors: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors: Maryann
authors: M
authors: Gyongyosi
authors: 3rd Department of Medicine (Cardiology and Emergency Medicine) Wilhelminenspital, Vienna, Austria.
authors: Kurt
authors: K
authors: Huber
authors: Prato Hospital, Prato, Italy.
authors: Francesco
authors: F
authors: Bellandi
authors: II Department of Cardiology, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Dariusz
authors: D
authors: Dudek
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D004534:Egypt; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab