Characteristics, treatment and outcome of patients with non-ST-elevation acute coronary syndromes and multivessel coronary artery disease: observations from PURSUIT (platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrelin therapy).

Abstract

BACKGROUND:

The 6-month clinical outcome of patients with multivessel disease enrolled in PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) is described. Patients with complete angiography data were included; multivessel disease was stratified according to the treatment strategy applied early during hospitalization, i.e. medical treatment, percutaneous coronary intervention (PCI) (balloon), PCI (stent), or coronary artery bypass grafting (CABG).

METHODS:

Patients were divided into three groups according to the treatment strategy applied during the first 30 days of enrolment. Patients who did not undergo a percutaneous or surgical coronary intervention were classified as medically treated. Patients who underwent a PCI (prior to a possible CABG) were separated from those who underwent a CABG (prior to a possible PCI). The PCI group was further subdivided: patients receiving >/=1 coronary stents were separated from those in whom no stents were used.

RESULTS:

The mortality rate at 30 days was 6.7, 3.9, 2.4 and 4.8% for the medical treatment, PCI (balloon), PCI (stent) and CABG groups, respectively (p value = 0.002). Differences as observed at 30 days were still present at 6-month follow-up with 11.1, 5.8, 5.5 and 6.5% mortality event rates for the aforementioned groups (p value = 0.002). The 30-day myocardial infarction (MI) rate according to the opinion of the Clinical Events Committee was lower among medically than non-medically treated patients, with the highest event rate observed in the CABG group (27.7%). Approximately half of the MIs in the PCI and CABG subgroups occurred within 48 h after the procedure.

CONCLUSIONS:

The observed differences in clinical outcomes are explained by an imbalance in baseline characteristics and comorbid conditions between the analyzed groups of patients.

• Authors: Arno Breeman, Nestor Mercado, Mattie Lenzen, Marcel M J van den Brand, Robert A Harrington, Robert M Califf, Eric J Topol, Maarten L Simoons, Eric Boersma, PURSUIT Investigators
• Journal: Cardiology (Cardiology) Vol. 98 Issue 4 Pg. 195-201 ( 2002) ISSN: 0008-6312 [Print] Switzerland
• PMID: 12566649 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright 2002 S. Karger AG, Basel

Chemical References

• Peptides
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Eptifibatide

Topics

• Acute Disease
• Aged
• Angina, Unstable (diagnostic imaging, drug therapy, surgery)
• Angioplasty, Balloon, Coronary
• Blood Vessel Prosthesis Implantation
• Coronary Angiography
• Coronary Artery Bypass
• Coronary Artery Disease (diagnostic imaging, drug therapy, surgery)
• Eptifibatide
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, drug therapy, surgery)
• Outcome Assessment, Health Care
• Peptides (therapeutic use)
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors, therapeutic use)
• Severity of Illness Index
• Stents
• Syndrome
• Time Factors