Copyright © 2002 by the European Society of Cardiology.
Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy
a Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
b Stanford University School of Medicine, Palo Alto, CA, U.S.A.
c Kerckhoff Heart Centre, Bad Nauheim, Germany
d Baylor College of Medicine, The Methodist Hospital, Houston, TX, U.S.A.
e Montreal Heart Institute, Montreal, Canada
f Green Lane Hospital, Auckland, New Zealand
revised December 31, 2001; accepted January 2, 2002
Abstract
Aims To assess the efficacy of platelet glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed.
Methods and Results We performed a meta-analysis of the randomized clinical trials of platelet glycoprotein IIb/IIIa inhibitor therapy in the medical management of non-ST-elevation acute coronary syndromes. Among 29570 patients, IIb/IIIa integrin blockade was associated with a reduction in death or non-fatal myocardial infarction at 30 days, from 11·5% to 10·7% (odds ratio 0·91,P =0·02). Patients undergoing percutaneous coronary intervention during index hospitalization sustained a greater reduction in ischaemic events (odds ratio 0·82, P=0·01) than patients medically managed (odds ratio 0·95, P=0·27). Among patients undergoing intervention, the benefit was more pronounced if the procedure was performed during glycoprotein IIb/IIIa inhibitor infusion (odds ratio 0·74; P=0·02), than if revascularization was performed after drug discontinuation (odds ratio 0·87,P =0·17).
Conclusion This analysis, including the entire large-scale trial experience of intravenous glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed, demonstrates an overall significant, albeit moderate, reduction in 30-day death or myocardial infarction associated with therapy. Although not based on a prospectively defined hypothesis, the findings suggest a gradient of benefit conferred by these agents depending on the revascularization strategy used. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Acute coronary syndromes, abciximab, eptifibatide, lamifiban, tirofiban, glycoprotein IIb/IIIa receptor inhibitors
f1 Correspondence: Eric J. Topol, MD, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, U.S.A.
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