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
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.
|Keywords||*Angioplasty, Transluminal, Percutaneous Coronary, Angina, Unstable/*drug therapy, Antibodies, Monoclonal/therapeutic use, Electrocardiography, Female, Humans, Immunoglobulin Fab Fragments/therapeutic use, Male, Middle aged, Peptides/therapeutic use, Platelet Aggregation Inhibitors/therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors, Randomized Controlled Trials, Tyrosine/analogs & derivatives/therapeutic use, coronary disease, glycoproteins, intervention|
Akkerhuis, K.M, Théroux, P, Califf, R.M, Topol, E.J, Simoons, M.L, & Boersma, H. (1999). Platelet Glycoprotein IIb/IIIa Receptor Inhibition in Non-ST-Elevation Acute Coronary Syndromes. Circulation (Baltimore), 100(20), 2045–2048. Retrieved from http://hdl.handle.net/1765/9193
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