Document Detail


Patients with acute coronary syndromes without persistent ST elevation undergoing percutaneous coronary intervention benefit most from early intervention with protection by a glycoprotein IIb/IIIa receptor blocker.
MedLine Citation:
PMID:  11792139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Many patients with acute coronary syndromes are offered percutaneous coronary intervention. However, the appropriate indications for, and optimal timing of, such procedures are uncertain. We analysed timing of intervention and associated events (death and myocardial infarction) in the PURSUIT trial in which 9461 patients received a platelet glycoprotein IIb/IIIa inhibitor, eptifibatide, or placebo for 72 h. Other treatment was left to the investigators. 2430 patients underwent percutaneous coronary intervention within 30 days. Four groups were distinguished, who underwent percutaneous coronary intervention on day 1; on days 2 or 3; at 4 to 7 days; or between 8 until 30 days, for eptifibatide- and placebo-treated patients. RESULTS: The four groups treated with placebo demonstrated total 30-day events of 15.9% for day 1 percutaneous coronary intervention, 17.7%, 15.0% and 18.2%, respectively, for successive intervals of later intervention. Later intervention was associated with more pre-procedural events (2.2% to 13.7%, P=0.001) which was balanced by a decrease in procedure-related events (12.1 to 3.1%, P=0.001), while the overall 30-day event rates were similar. Eptifibatide-treated patients with percutaneous coronary intervention on day 1 had the lowest rate of 30-day events (9.2%, P<0.05 vs other groups). In this group, pre-procedural risk was only 0.3%, while percutaneous coronary intervention on eptifibatide treatment was associated with low procedural risk (7.2%). The total 30-day event rate for later percutaneous coronary intervention in patients receiving eptifibatide was 14.0 on days 2 and 3, 15.0% for days 4 to 7 and 17.4% for days 7 to 30, respectively. CONCLUSION: Patients treated with a platelet glycoprotein IIb/IIIa receptor blocker, and early percutaneous coronary intervention (within 24 h) had the lowest event rate in this post hoc analysis. Thus 'watchful waiting' may not be the optimal strategy. Rather an early invasive strategy with percutaneous coronary intervention under protection of a platelet glycoprotein IIb/IIIa receptor blocker should be considered in selected patients. Randomized trials are warranted to verify this issue.
Authors:
E Ronner; E Boersma; K M Akkerhuis; R A Harrington; A M Lincoff; J W Deckers; K Karsch; N S Kleiman; A Vahanian; E J Topol; R M Califf; M L Simoons
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  23     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-01-16     Completed Date:  2002-05-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  239-46     Citation Subset:  IM    
Copyright Information:
Copyright 2001 The European Society of Cardiology.
Affiliation:
University Hospital Rotterdam, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Angioplasty, Transluminal, Percutaneous Coronary*
Combined Modality Therapy
Coronary Disease / complications,  mortality,  therapy*
Electrocardiography*
Endpoint Determination
Female
Follow-Up Studies
Humans
Male
Middle Aged
Peptides / antagonists & inhibitors,  therapeutic use
Placebos
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*,  therapeutic use*
Platelet Glycoprotein GPIb-IX Complex / antagonists & inhibitors*,  therapeutic use*
Platelet Membrane Glycoproteins*
Postoperative Complications / etiology,  mortality
Survival Analysis
Syndrome
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Peptides; 0/Placebos; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Platelet Glycoprotein GPIb-IX Complex; 0/Platelet Membrane Glycoproteins; 0/eptifibatide; 0/glycoprotein receptor GPIb-IX
Comments/Corrections
Comment In:
Eur Heart J. 2002 Sep;23(17):1404; author reply 1404   [PMID:  12269269 ]
Eur Heart J. 2002 Feb;23(3):194-7   [PMID:  11792132 ]

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