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European Heart Journal 2002 23(14):1102-1111; doi:10.1053/euhj.2001.3151
Copyright © 2002 by the European Society of Cardiology.
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Does eptifibatide confer a greater benefit to patients with unstable angina than with non-ST segment elevation myocardial infarction?. Insights from the PURSUIT Trial

W.-C. Changa, R.A. Harringtonb, M.L. Simoonsc, R.M. Califfb, A.M. Lincoffd and P.W. Armstronga,f1

a University of Alberta, Edmonton, Alberta, Canada
b Duke Clinical Research Institute, Durham, NC, U.S.A.
c Erasmus University, Rotterdam, The Netherlands
d Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

revised December 18, 2001; accepted December 18, 2001

Abstract

Aims To evaluate the differential effects of eptifibatide therapy on unstable angina vs non-ST elevation myocardial infarction at enrollment, since the separate impact on these two major diagnostic subsets of acute coronary syndrome patients has not been fully investigated.

Methods and Results We examined the 9461 patients in the PURSUIT trial (conducted between 1995 and 1997) to compare the effects of eptifibatide on unstable angina and myocardial infarction. The study showed greater and more consistent effects of eptifibatide therapy on unstable angina than non-ST elevation myocardial infarction in reducing 30-day death/(re)infarction (from the unadjusted rate of 13·0% to 11·2%, P=0·059 for unstable angina; and 18·9% to 17·9%,P =0·387 for myocardial infarction), especially among patients who underwent early percutaneous coronary intervention (odds ratios=0·49 and 0·86, 95% confidence intervals=0·30–0·80 and 0·53–1·42, respectively, for unstable angina and myocardial infarction). The only subgroup for whom the benefit of eptifibatide was not evident was female myocardial infarction patients who did not undergo early percutaneous coronary intervention.

Conclusions These data suggest that eptifibatide benefited unstable angina patients more than myocardial infarction patients, especially among those who underwent early percutaneous coronary intervention, and support its use as concomitant therapy with early percutaneous coronary intervention especially in female myocardial infarction patients.

Key Words: Eptifibatide, unstable angina, myocardial infarction, angioplasty

f1 Correspondence: Paul W. Armstrong, MD, Division of Cardiology, Department of Medicine, 2-51 Medical Sciences Building, University of Alberta Edmonton, Alberta, Canada T6G 2H7.


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