Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes - Early benefit during medical treatment only, with additional protection during percutaneous coronary intervention

Background-Glycoprotein (GP) IIb/IIIa receptor blockers prevent life-threat ening cardiac complications in patients with acute coronary syndromes witho ut ST-segment elevation and protect against thrombotic complications associ ated with percutaneous coronary interventions (PCIs), The question arises a s to whether these 2 beneficial effects are independent and additive. Methods and Results-We analyzed data from the CAPTURE, PURSUIT, and PRISM-P LUS randomized trials, which studied the effects of the GP IIb/IIIa inhibit ors abciximab, eptifibatide, and tirofiban, respectively, in acute coronary syndrome patients without persistent ST-segment elevation, with a period o f study drug infusion before a possible PCI, During the period of pharmacol ogical treatment, each trial demonstrated a significant reduction in the ra te 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 ass igned GP IIb/IIIa inhibition and 1396 placebo patients. The event rate duri ng 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 syndro mes without persistent ST-segment elevation. In addition, in patients subse quently undergoing PCI, GP IIb/IIIa inhibition protects against myocardial damage associated with the intervention.