TY - JOUR
T1 - Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes
T2 - Gradient of benefit related to the revascularization strategy
AU - Roffi, M.
AU - Chew, D. P.
AU - Mukherjee, D.
AU - Bhatt, D. L.
AU - White, J. A.
AU - Moliterno, D. J.
AU - Heeschen, C.
AU - Hamm, C. W.
AU - Robbins, M. A.
AU - Kleiman, N. S.
AU - Théroux, P.
AU - White, H. D.
AU - Topol, E. J.
PY - 2002/9
Y1 - 2002/9
N2 - 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 29 570 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.
AB - 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 29 570 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.
KW - Abciximab
KW - Acute coronary syndromes
KW - Eptifibatide
KW - Glycoprotein IIb/IIIa receptor inhibitors
KW - Lamifiban
KW - Tirofiban
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U2 - 10.1053/euhj.2002.3160
DO - 10.1053/euhj.2002.3160
M3 - Article
C2 - 12208224
AN - SCOPUS:0036764581
VL - 23
SP - 1441
EP - 1448
IS - 18
ER -