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European Heart Journal Advance Access published online on November 7, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn480
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Long-term effectiveness of early administration of glycoprotein IIb/IIIa agents to real-world patients undergoing primary percutaneous interventions: results of a registry study in an ST-elevation myocardial infarction network

Paolo Ortolani1,*, Antonio Marzocchi1, Cinzia Marrozzini1, Tullio Palmerini1, Francesco Saia1, Nevio Taglieri1, Federica Baldazzi1, Gianni Dall'Ara1, Paola Nardini1, Silvia Gianstefani1, Paolo Guastaroba2, Roberto Grilli2 and Angelo Branzi1

1 Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
2 Emilia-Romagna Regional Health Agency, Bologna, Italy

Received 4 January 2008; revised 3 September 2008; accepted 9 October 2008.

* Corresponding author. Tel: +39 051 636 4477, Fax: +39 051 344859, Email: paortol{at}tin.it

Aims: To evaluate the clinical impact of early administration of glycoprotein IIb/IIIa agents (IIb/IIIa agents) in the context of a dedicated hub and spoke network allowing very prompt pharmacological/mechanical interventions.

Methods and results: Using a prospective database, we conducted a cohort study of ST-elevation myocardial infarction (STEMI) patients (n = 1124) undergoing primary percutaneous coronary interventions (PPCIs) and IIb/IIIa agents administration (period, 2003–2006). Comparisons were planned between patients receiving early IIb/IIIa agents administration (in hub/spoke centre emergency departments or during ambulance transfer; early group, n = 380) or delayed administration (in the catheterization laboratory; late group, n = 744). The primary outcome measure was long-term overall mortality/re-infarction. Baseline characteristics of the two groups were largely comparable. Angiographically, early group patients more often achieved pre-PPCI TIMI Grade 2–3 and TIMI Grade 3 flow. Clinically, the early administration group experienced lower 2-year risk of unadjusted mortality/re-infarction (17 vs. 23%; P = 0.01). After adjustment for potential confounders, early administration was associated with favourable outcome in the overall population (HR = 0.71, P = 0.03) and in high-risk subgroups (TIMI risk index >25, HR = 0.64, P = 0.02; Killip class >1, HR = 0.54, P = 0.01).

Conclusion: In patients treated by PPCI within a STEMI network setting, early administration of IIb/IIIa agents may provide long-term clinical benefits. Notably, these results appeared magnified in high-risk patients.

Key Words: Myocardial infarction • Percutaneous coronary interventions • Glycoprotein IIb/IIIa inhibitors


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