Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy.

Abstract

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 29570 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.

• Authors: M Roffi, D P Chew, D Mukherjee, D L Bhatt, J A White, D J Moliterno, C Heeschen, C W Hamm, M A Robbins, N S Kleiman, P Théroux, H D White, E J Topol
• Journal: European heart journal (Eur Heart J) Vol. 23 Issue 18 Pg. 1441-8 (Sep 2002) ISSN: 0195-668X [Print] England
• PMID: 12208224 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Heparin

Topics

• Acute Disease
• Angina, Unstable (drug therapy)
• Angioplasty, Balloon, Coronary
• Anticoagulants (therapeutic use)
• Coronary Artery Bypass
• Drug Evaluation
• Endpoint Determination
• Heparin (therapeutic use)
• Humans
• Myocardial Infarction (mortality, therapy)
• Odds Ratio
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Randomized Controlled Trials as Topic
• Risk Assessment
• Survival Analysis
• Treatment Outcome