Document Detail


Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation.
MedLine Citation:
PMID:  10987585     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: 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.
Authors:
D 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
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  36     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-09-27     Completed Date:  2000-09-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  685-92     Citation Subset:  AIM; IM    
Affiliation:
Rabin Medical Center, Petah Tikva, Israel.
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MeSH Terms
Descriptor/Qualifier:
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
Chemical
Reg. No./Substance:
0/Platelet Glycoprotein GPIIb-IIIa Complex

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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