The PURSUIT results in perspective

Platelet inhibition with glycoprotein IIb/IIIa receptor inhibitors has been shown to be beneficial for patients with non-ST-segment elevation acute co ronary syndromes (ACS). However, many existing trial data are derived from small studies, and the validity of the end-points used has been questioned. Furthermore, the clinical trial environment differs from normal clinical p ractice and, although trial results can be extrapolated, they may not be di rectly applicable to standard practice. The PURSUIT (Platelet IIb/IIIa in U nstable Angina: Receptor Suppression Using Integrilin Therapy) trial was de signed to include a very large patient population and to replicate normal p ractice as closely as possible, thus providing data with direct relevance t o practising physicians. Patients with non-ST-segment elevation ACS were ra ndomized to receive either eptifibatide or placebo, but all other treatment decisions were left to the physician. The incidence of death or myocardial infarction (MI) was significantly reduced by 1.5% in patients receiving ep tifibatide. This absolute reduction appeared early and was fully maintained at 30 days. The global nature of PURSUIT revealed some marked regional dif ferences in patient populations and treatment regimes. While variations in practice may have affected outcomes, it is not possible to draw any conclus ions an this without further analysis.