November 16, 1999Circulation304 citationsOpen Access
Platelet Glycoprotein IIb/IIIa Receptor Inhibition in Non–ST-Elevation Acute Coronary Syndromes
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Key Result
Glycoprotein IIb/IIIa inhibitors significantly reduced the rate of death or nonfatal myocardial infarction compared with placebo during medical treatment (2.5% vs 3.8%; P<0.001) and post-PCI.
Study Design
Type
Meta-Analysis (n=12,296)
Multicenter
Yes
Structured PICO
Do Glycoprotein IIb/IIIa inhibitors reduce the rate of death or nonfatal myocardial infarction in patients with non-ST-elevation acute coronary syndromes?
P
Population
12,296 patients with acute coronary syndromes without persistent ST-segment elevation from 3 randomized trials (CAPTURE, PURSUIT, and PRISM-PLUS)
I
Intervention
Glycoprotein (GP) IIb/IIIa inhibitors (abciximab, eptifibatide, or tirofiban) infused before a possible percutaneous coronary intervention (PCI)
C
Comparator
Placebo
O
Outcome
Composite of death or nonfatal myocardial infarction during the period of pharmacological treatment and during the first 48 hours after PCIcomposite
Glycoprotein IIb/IIIa inhibitors provide an early benefit during medical treatment and protect against myocardial damage during subsequent PCI in patients with non-ST-elevation acute coronary syndromes.
Main Result
Effect estimate: 34% relative reduction
Absolute Event Rate: 2.5% vs 3.8%
p-value: p=<0.001
Abstract
BACKGROUND: Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threatening cardiac complications in patients with acute coronary syndromes without ST-segment elevation and protect against thrombotic complications associated with percutaneous coronary interventions (PCIs). The question arises as to whether these 2 beneficial effects are independent and additive. METHODS AND RESULTS: We analyzed data from the CAPTURE, PURSUIT, and PRISM-PLUS randomized trials, which studied the effects of the GP IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban, respectively, in acute coronary syndrome patients without persistent ST-segment elevation, with a period of study drug infusion before a possible PCI. During the period of pharmacological treatment, each trial demonstrated a significant reduction in the rate of death or nonfatal myocardial infarction in patients randomized to the GP IIb/IIIa inhibitor compared with placebo. The 3 trials combined showed a 2.5% event rate in this period in the GP IIb/IIIa inhibitor group (N=6125) versus 3.8% in placebo (N=6171), which implies a 34% relative reduction (P<0.001). During study medication, a PCI was performed in 1358 patients assigned GP IIb/IIIa inhibition and 1396 placebo patients. The event rate during the first 48 hours after PCI was also significantly lower in the GP IIb/IIIa inhibitor group (4. 9% versus 8.0%; 41% reduction; P<0.001). No further benefit or rebound effect was observed beyond 48 hours after the PCI. CONCLUSIONS: There is conclusive evidence of an early benefit of GP IIb/IIIa inhibitors during medical treatment in patients with acute coronary syndromes without persistent ST-segment elevation. In addition, in patients subsequently undergoing PCI, GP IIb/IIIa inhibition protects against myocardial damage associated with the intervention.
Cite This Study
Boersma et al. (1999) conducted a meta-analysis in Non-ST-elevation acute coronary syndromes (n=12,296). Glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban) vs. Placebo was evaluated on Death or nonfatal myocardial infarction during pharmacological treatment (34% relative reduction, p=<0.001). Glycoprotein IIb/IIIa inhibitors significantly reduced the rate of death or nonfatal myocardial infarction compared with placebo during medical treatment (2.5% vs 3.8%; P<0.001) and post-PCI.