Skip Navigation

European Heart Journal 2002 23(14):1102-1111; doi:10.1053/euhj.2001.3151
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (1)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Chang, W.-C.
Right arrow Articles by Armstrong, P.W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chang, W.-C.
Right arrow Articles by Armstrong, P.W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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.

References

  1. Topol EJ. Toward a new frontier in myocardial reperfusion therapy. Emerging platelet preeminence. Circulation. 1998;97:211–218[Free Full Text]
  2. Kong DF, Califf RM, Miller DP. Outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation. 1998;98:2829–2835[Abstract/Free Full Text]
  3. Madan M, Berkowitz SD, Tcheng JE. Glycoprotein IIb/IIIa integrin blockade. Circulation. 1998;98:2629–2635[Free Full Text]
  4. Lincoff AM, Califf RM, Topol EJ. Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease. J Am Coll Cardiol. 2000;35:1103–1115[Abstract/Free Full Text]
  5. Antman EM, Cohen M, Bernink PJL. The TIMI risk score for unstable angina/non-ST elevation MI. A method for prognostication and therapeutic decision making. JAMA. 2000;284:835–842[Abstract/Free Full Text]
  6. Armstrong PW, Fu Y, Chang W-C. Acute coronary syndromes in the GUSTO-IIb Trial. Prognostic insights and impact of recurrent ischemia. Circulation. 1998;98:1860–1868[Abstract/Free Full Text]
  7. Boersma E, Pieper K, Steyerberg EW. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation. Results from an international trial of 9461 patients. Circulation. 2000;101:2557–2567[Abstract/Free Full Text]
  8. Calvin JE, Klein LW, VandenBerg BJ. Risk stratification in unstable angina. Prospective validation of the Braunwald classification. JAMA. 1995;273:136–141[Abstract/Free Full Text]
  9. Fu Y, Chang W-C, Mark D. Canadian-American differences in the management of acute coronary syndromes in the GUSTO-IIb trial. One-year follow-up of patients without ST-segment elevation. Circulation. 2000;102:1375–1381[Abstract/Free Full Text]
  10. Heeschen C, Hamm CW, Goldmann B, Deu A, Langenbrink L, White H. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. Lancet. 1999;354:1757–1762[CrossRef][Web of Science][Medline]
  11. N Engl J Med. 1998;339:436–443[Abstract/Free Full Text]
  12. Harrington RA. Design and methodology of the PURSUIT trial: evaluating eptifibatide for acute ischemic coronary syndromes. Am J Cardiol. 1997;80:34B–38B[CrossRef][Medline]
  13. Kleiman NS, Lincoff AM, Flaker GC. Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. Circulation. 2000;101:751–757[Abstract/Free Full Text]
  14. N Engl J Med. 1994;330:956–961[Abstract/Free Full Text]
  15. Lincoff AM, Califf RM, Anderson KM. Evidence for prevention of death and myocardial infarction with platelet membrane glycoprotein IIb/IIIa receptor blockade by abciximab (c7E3 Fab) among patients with unstable angina undergoing percutaneous coronary revascularization. J Am Coll Cardiol. 1997;31:149–156
  16. N Engl J Med. 1997;336:1689–1696[Abstract/Free Full Text]
  17. Lancet. 1997;349:1420–1435
  18. Akkerhuis KM, Deckers JW, Boersma E. Geographic variability in outcomes within an international trial of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes. Results from PURSUIT. European Heart J. 2000;21:371–381[Abstract/Free Full Text]
  19. Boden WE, O'Rourke RA, Crawford MH. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med. 1998;338:1785–1792[Abstract/Free Full Text]
  20. Hochman JS, Tamis JE, Thompson TD. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999;341:226–232[Abstract/Free Full Text]
  21. Lincoff AM, Harrington RA, Califf RM. Management of patients with acute coronary syndromes in the United States by platelet Glycoprotein Iib/IIIa inhibition. Insights from the Platelet Glycoprotein Iib.IIIa in Unstable Angina: Receptor Supprossion Using Integrilin Therapy (PURSUIT) Trial. Circulation. 2000;102:1093–1100[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (1)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Chang, W.-C.
Right arrow Articles by Armstrong, P.W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chang, W.-C.
Right arrow Articles by Armstrong, P.W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?