(Circulation. 1999;100:2045-2048.)
© 1999 American Heart Association, Inc.
Brief Rapid Communication |
Platelet Glycoprotein IIb/IIIa Receptor Inhibition in Non–ST-Elevation Acute Coronary Syndromes
Early Benefit During Medical Treatment Only, With Additional Protection During Percutaneous Coronary Intervention
From the Thoraxcenter, University Hospital Rotterdam, Netherlands (E.B., K.M.A., M.L.S.); the University of Montreal, Canada (P.T.); Duke Clinical Research Institute, Durham, NC (R.M.C.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
Correspondence to Eric Boersma, University Hospital Rotterdam, Room H543, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail boersma{at}thch.azr.nl
Background—Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threatening cardiac complications in patients with acute coronary syndromes without ST-segment elevation and protect against thrombotic complications associated with percutaneous coronary interventions (PCIs). The question arises as to whether these 2 beneficial effects are independent and additive.
Methods and Results—We analyzed data from the CAPTURE, PURSUIT, and PRISM-PLUS randomized trials, which studied the effects of the GP IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban, respectively, in acute coronary syndrome patients without persistent ST-segment elevation, with a period of study drug infusion before a possible PCI. During the period of pharmacological treatment, each trial demonstrated a significant reduction in the rate of death or nonfatal myocardial infarction in patients randomized to the GP IIb/IIIa inhibitor compared with placebo. The 3 trials combined showed a 2.5% event rate in this period in the GP IIb/IIIa inhibitor group (N=6125) versus 3.8% in placebo (N=6171), which implies a 34% relative reduction (P<0.001). During study medication, a PCI was performed in 1358 patients assigned GP IIb/IIIa inhibition and 1396 placebo patients. The event rate during the first 48 hours after PCI was also significantly lower in the GP IIb/IIIa inhibitor group (4.9% versus 8.0%; 41% reduction; P<0.001). No further benefit or rebound effect was observed beyond 48 hours after the PCI.
Conclusions—There is conclusive evidence of an early benefit of GP IIb/IIIa inhibitors during medical treatment in patients with acute coronary syndromes without persistent ST-segment elevation. In addition, in patients subsequently undergoing PCI, GP IIb/IIIa inhibition protects against myocardial damage associated with the intervention.
Key Words: coronary disease • glycoproteins • intervention
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