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

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

Research output: Contribution to journalArticle

138 Citations (Scopus)

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 29 570 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.

LanguageEnglish
Pages1441-1448
Number of pages8
JournalEuropean heart journal
Volume23
Issue number18
DOIs
Publication statusPublished - Sep 2002

Keywords

  • Abciximab
  • Acute coronary syndromes
  • Eptifibatide
  • Glycoprotein IIb/IIIa receptor inhibitors
  • Lamifiban
  • Tirofiban

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Roffi, M. ; Chew, D. P. ; Mukherjee, D. ; Bhatt, D. L. ; White, J. A. ; Moliterno, D. J. ; Heeschen, C. ; Hamm, C. W. ; Robbins, M. A. ; Kleiman, N. S. ; Théroux, P. ; White, H. D. ; Topol, E. J. / Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes : Gradient of benefit related to the revascularization strategy. In: European heart journal. 2002 ; Vol. 23, No. 18. pp. 1441-1448.
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title = "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 29 570 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.",
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author = "M. Roffi and Chew, {D. P.} and D. Mukherjee and Bhatt, {D. L.} and White, {J. A.} and Moliterno, {D. J.} and C. Heeschen and Hamm, {C. W.} and Robbins, {M. A.} and Kleiman, {N. S.} and P. Th{\'e}roux and White, {H. D.} and Topol, {E. J.}",
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Roffi, M, Chew, DP, Mukherjee, D, Bhatt, DL, White, JA, Moliterno, DJ, Heeschen, C, Hamm, CW, Robbins, MA, Kleiman, NS, Théroux, P, White, HD & Topol, EJ 2002, 'Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes: Gradient of benefit related to the revascularization strategy', European heart journal, vol. 23, no. 18, pp. 1441-1448. https://doi.org/10.1053/euhj.2002.3160

Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes : Gradient of benefit related to the revascularization strategy. / Roffi, M.; Chew, D. P.; Mukherjee, D.; Bhatt, D. L.; White, J. A.; Moliterno, D. J.; Heeschen, C.; Hamm, C. W.; Robbins, M. A.; Kleiman, N. S.; Théroux, P.; White, H. D.; Topol, E. J.

In: European heart journal, Vol. 23, No. 18, 09.2002, p. 1441-1448.

Research output: Contribution to journalArticle

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T1 - Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes

T2 - European heart journal

AU - Roffi, M.

AU - Chew, D. P.

AU - Mukherjee, D.

AU - Bhatt, D. L.

AU - White, J. A.

AU - Moliterno, D. J.

AU - Heeschen, C.

AU - Hamm, C. W.

AU - Robbins, M. A.

AU - Kleiman, N. S.

AU - Théroux, P.

AU - White, H. D.

AU - Topol, E. J.

PY - 2002/9

Y1 - 2002/9

N2 - 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 29 570 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.

AB - 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 29 570 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.

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KW - Eptifibatide

KW - Glycoprotein IIb/IIIa receptor inhibitors

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