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.

Abstract

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.

• Authors: E Boersma, K M Akkerhuis, P Théroux, R M Califf, E J Topol, M L Simoons
• Journal: Circulation (Circulation) Vol. 100 Issue 20 Pg. 2045-8 (Nov 16 1999) ISSN: 1524-4539 [Electronic] United States
• PMID: 10562258 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Peptides
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Tyrosine
• Tirofiban
• Eptifibatide
• Abciximab

Topics

• Abciximab
• Angina, Unstable (drug therapy)
• Angioplasty, Balloon, Coronary
• Antibodies, Monoclonal (therapeutic use)
• Electrocardiography
• Eptifibatide
• 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 as Topic
• Tirofiban
• Tyrosine (analogs & derivatives, therapeutic use)