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To the Editor: Dr Montalescot and colleagues analyzed 6 trials of early vs late Gp IIb/IIIa inhibitors and concluded that early administration confers significant angiographic and clinical benefit.¹ I have concerns about whether this interpretation is warranted.

First, it appears that studies using electrocardiographic (ST segment resolution) end points and angiographic (Thrombolysis in Myocardial Infarction [TIMI] flow) end points were combined. It is possible that if the study by Zorman et al² (which used electrocardiographic criteria as a primary end point) had been excluded from the analysis, the authors would not have found significant benefit.

Second, even with a combined clinical end point including death, reinfarction, rehospitalization, or revascularization, there was no significant benefit to early administration, which would speak against "favorable trends for clinical outcome when treatment is started at first medical contact."¹ Finally, there was no analysis of major bleeding with early administration. This is a particular concern . . . [Full Text of this Article]

Joel Klein, MD, MA
joel.klein@earthlink.net
Department of Emergency Medicine
North Arundel Hospital
Glen Burnie, Md

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