Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (Platelet Glycoprotein IIb/IIIa in unstable angina: receptor suppression using integreling therapy)
BACKGROUND: The 6-month clinical outcome of patients with multivessel disease enrolled in PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) is described. Patients with complete angiography data were included; multivessel disease was stratified according to the treatment strategy applied early during hospitalization, i.e. medical treatment, percutaneous coronary intervention (PCI) (balloon), PCI (stent), or coronary artery bypass grafting (CABG). METHODS: Patients were divided into three groups according to the treatment strategy applied during the first 30 days of enrolment. Patients who did not undergo a percutaneous or surgical coronary intervention were classified as medically treated. Patients who underwent a PCI (prior to a possible CABG) were separated from those who underwent a CABG (prior to a possible PCI). The PCI group was further subdivided: patients receiving >/=1 coronary stents were separated from those in whom no stents were used. RESULTS: The mortality rate at 30 days was 6.7, 3.9, 2.4 and 4.8% for the medical treatment, PCI (balloon), PCI (stent) and CABG groups, respectively (p value = 0.002). Differences as observed at 30 days were still present at 6-month follow-up with 11.1, 5.8, 5.5 and 6.5% mortality event rates for the aforementioned groups (p value = 0.002). The 30-day myocardial infarction (MI) rate according to the opinion of the Clinical Events Committee was lower among medically than non-medically treated patients, with the highest event rate observed in the CABG group (27.7%). Approximately half of the MIs in the PCI and CABG subgroups occurred within 48 h after the procedure. CONCLUSIONS: The observed differences in clinical outcomes are explained by an imbalance in baseline characteristics and comorbid conditions between the analyzed groups of patients.
|Keywords||Acute Disease, Aged, Angioplasty Coronary, Blood Vessel Prosthesis Implantation, Coronary Angiography, Coronary Arteriosclerosis, Coronary Artery Bypass, Female, Follow-Up Studies, Human, Male, Middle Aged, Myocardial Infarction, Outcome Assessment, Peptides, Percutaneous Coronary, Platelet Aggregation Inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex, Severity of Illness Index, Stents, Syndrome, Time Factors, Transluminal Coronary, antagonists, drug therapy, eptifibatide, inhibitors, radiography, surgery, unstable angina|
|Persistent URL||dx.doi.org/10.1159/000067321, hdl.handle.net/1765/5696|
|Journal||Cardiology: international journal of cardiovascular medicine, surgery and pathology|
|Rights||Open Access as permitted by Karger|
Breeman, A, Mercado, N.F, Lenzen, M.J, Harrington, R.A, Califf, R.M, Topol, E.J, … Boersma, H. (2002). Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (Platelet Glycoprotein IIb/IIIa in unstable angina: receptor suppression using integreling therapy). Cardiology: international journal of cardiovascular medicine, surgery and pathology, 98(4), 195–201. doi:10.1159/000067321