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Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation.

AbstractOBJECTIVES:
The study examined whether antiplatelet treatment with eptifibatide affected the frequency and outcome of shock among patients in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial who had acute coronary syndromes but not persistent ST-segment elevation.
BACKGROUND:
Preliminary reports suggest a salutary effect of antiplatelet agents when shock complicates acute myocardial infarction.
METHODS:
We analyzed the impact of antiplatelet treatment with eptifibatide on the frequency and outcome of cardiogenic shock developing after enrollment. PURSUIT was a double-blind, randomized trial that examined the efficacy of eptifibatide (180 microg/kg bolus + continuous infusion of 2.0 microg/kg/min for < or =96 h) versus placebo among patients who had acute coronary syndromes but not persistent ST-segment elevation.
RESULTS:
Shock developed in 2.5% of the 9,449 patients at a median (25th, 75th interquartiles) of 94.0 (38, 206) h. Death by 30 days occurred in 65.8% of shock patients. Patients who had acute myocardial infarction upon enrollment had a greater incidence of shock (2.9% vs. 2.1%, p = 0.01), developed shock earlier (40.2% <48 h vs. 20.9%, p = 0.001), and had higher 30-day mortality from shock (77.2% vs. 52.7%, p = 0.001). Randomization to eptifibatide did not affect the occurrence of shock (p = 0.71, adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.72-1.25). However, shock patients treated with eptifibatide had significantly reduced adjusted odds of 30-day death (p = 0.03, adjusted OR = 0.51, 95% CI = 0.28-0.94).
CONCLUSIONS:
Patients with shock treated with eptifibatide had significantly reduced adjusted odds of death, suggesting a salutary effect of antiplatelet therapy on shock. This finding warrants verification in specifically designed studies.
AuthorsD Hasdai, R A Harrington, J S Hochman, R M Califf, A Battler, J W Box, M L Simoons, J Deckers, E J Topol, D R Holmes Jr
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 36 Issue 3 Pg. 685-92 (Sep 2000) ISSN: 0735-1097 [Print] UNITED STATES
PMID10987585 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
Chemical References
  • Platelet Glycoprotein GPIIb-IIIa Complex
Topics
  • Aged
  • Blood Platelets (metabolism)
  • Coronary Angiography
  • Coronary Disease (complications, physiopathology, radiography, therapy)
  • Double-Blind Method
  • Electrocardiography
  • Female
  • Heart-Assist Devices
  • Humans
  • Male
  • Middle Aged
  • Myocardial Revascularization
  • Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors, metabolism)
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Shock (etiology)
  • Syndrome
  • Time Factors

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