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- W2000603887 abstract "ContextGlycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors improve myocardial reperfusionand clinical outcomes of patients undergoing primary percutaneous coronaryintervention (PCI), but optimal timing of administration remains unclear.No systematic reviews have comprehensively examined the effects of early vsdelayed administration of these agents.ObjectiveTo perform a meta-analysis of randomized trials of early (prior to transferto the catheterization laboratory) vs late (at the time of PCI) intravenousadministration of Gp IIb/IIIa inhibitors in acute ST-segment elevation myocardialinfarction (STEMI).Data SourcesMEDLINE and the Cochrane Controlled Trials Register search of the literatureover the past 10 years; papers presented at major cardiac conferences; consultationwith national and international colleagues as well as Gp IIb/IIIa inhibitordrug manufacturers; and text and journal article bibliographies.Study Selection and Data ExtractionWe examined trials of randomized comparisons between early administrationat the point of initial contact (emergency department or ambulance) and lateadministration (catheterization laboratory) of Gp IIb/IIIa inhibitors in STEMI.Outcome data had to be available on both culprit artery patency evaluatedby Thrombolysis in Myocardial Infarction (TIMI) flow grades on admission andmortality. Two authors independently reviewed abstracts or complete articles.Six studies met inclusion criteria. Independent data extraction was performedby 2 reviewers and confirmed by consensus.Data SynthesisThe 6 trials enrolled 931 STEMI patients treated with abciximab (3 trials)or tirofiban (3 trials) in combination with primary PCI. TIMI grade 2 or 3flow (41.7% [194/465 vs 29.8% [139/466]) as well as TIMI grade 3 flow (20.3%[84/413] vs 12.2% [51/418]) were significantly more frequent in the earlygroup compared with the late group (odds ratio [OR], 1.69; 95% confidenceinterval [CI], 1.28-2.22; P<.001; and OR, 1.85;95% CI, 1.26-2.71; P<.001, respectively). Theearly administration of Gp IIb/IIIa inhibitors was associated with a 28% reductionof mortality from 4.7% to 3.4%, which was not significant but consistent withsimilar trends for reinfarction and the composite ischemic end point.ConclusionsIn a meta-analysis of 6 randomized trials, early administration of GpIIb/IIIa inhibitors in STEMI appeared to improve coronary patency with favorabletrends for clinical outcomes. These findings are supportive of a strategyof facilitated PCI. Further evaluations in adequately powered large trialsare awaited to confirm the clinical benefit of this strategy." @default.
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- W2000603887 date "2004-09-01" @default.
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- W2000603887 title "Early vs. late administration of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction. A meta-analysis" @default.
- W2000603887 doi "https://doi.org/10.1016/j.accreview.2004.08.042" @default.
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