Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes

Background-Platelet glycoprotein (GP) IIb/IIa antagonists prevent the compo site end point of death or myocardial infarction (MI) in patients with acut e coronary syndromes, There is uncertainty about whether this effect is con fined to patients who have percutaneous coronary interventions (PCIs) and w hether PCIs further prevent death or MI in patients already treated with GP IIb/IIIa antagonists. Methods and Results-PURSUIT patients were treated with the GP IIb/IIIa anta gonist eptifibatide or placebo; PCIs were performed according to physician practices. In 2253 of 9641 patients (23.4%), PCI was performed by 30 days. Early (<72 hours) PCI was performed in 1228 (12.7%), In 34 placebo patients (5.5%) and 10 treated with eptifibatide (1.7%) (P=0.001), MI preceded earl y PCI. In patients censored for PCI across the 30-day period, there was a s ignificant reduction in the primary composite end point in eptifibatide pat ients (P=0.035). Eptifibatide reduced 30-day events in patients who had ear ly PCI(11.6% versus 16.7%, P=0.01) and in patients who did not (14.6% versu s 15.6%, P=0.23). After adjustment for PCI propensity, there was no evidenc e that eptifibatide treatment effect differed between patients with or with out early PCI (P for interaction=0.634). PCI was not associated with a redu ction of the primary composite end point but was associated with a reduced (nonspecified) composite of death or Q-wave MI. This association disappeare d after adjustment for propensity for early PCI, Conclusions-Eptifibatide reduced the composite rates of death or MI in PCI patients and those managed conservatively.