Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation: Effect of inhibition of platelet glycoprotoin IIb/IIIa with eptifibatide
BACKGROUND: Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers. METHODS: The study population included patients enrolled in the PURSUIT trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) with known smoking status presenting with ischemic chest pain </=24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels. Patients were randomly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to standard therapy. The primary end point was a composite of death or nonfatal myocardial infarction within 30 days. RESULTS: Of the 9406 patients with known smoking status, 2677 were current smokers, 3086 were former smokers, and 3643 were nonsmokers. Cigarette smokers had better 30-day outcomes (12.3%, 16.8%, and 15.4% for smokers, former smokers, and nonsmokers, respectively; P =.001). However, after adjusting for differences in baseline clinical variables, smoking status was not a predictor of 30-day outcome (P =.45). There was a reduction in the composite end point overall with eptifibatide compared with placebo (14.3% vs 15. 7%, P =.054) but no interaction between smoking status and treatment strategy (P =.68). CONCLUSIONS: Among patients with ACS without persistent ST-segment elevation, cigarette smokers had better short-term outcomes because of their more favorable clinical profile. Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers, eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers.
|Keywords||Acute Disease, Aged, Angioplasty Coronary, Coronary Artery Bypass, Coronary Disease, Double-Blind Method, Electrocardiography, Female, Heart Catheterization, Human, Male, Middle Aged, Myocardial Infarction, Peptides, Percutaneous Coronary, Platelet Aggregation Inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex, Smoking, Support, Treatment Outcome, adverse effects, antagonists, drug therapy, eptifibatide, etiology, inhibitors, metabolism, mortality, physiopathology, therapy, transluminal Coronary, unstable angina|
Hasdai, D., Holmes, D.R., Jr, Criger, D.A., Topol, E.J., Califf, R.M., Wilcox, R.G., … Deckers, J.W.. (2000). Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation: Effect of inhibition of platelet glycoprotoin IIb/IIIa with eptifibatide. American Heart Journal, 139(3), 454–460. Retrieved from http://hdl.handle.net/1765/5739