Management of patients with acute coronary syndromes in the United States by platelet glycoprotein IIb/IIIa inhibition - Insights from the platelet glycoprotein IIb/IIIa in unstable angina: Receptor suppression using integrilin therapy (PURSUIT) trial

Background-A multinational, randomized, placebo-controlled trial (Platelet Glycoprotein II/IIIa in Unstable Angina: Receptor Suppression Using Integri lin Therapy, PURSUIT) demonstrated that the platelet glycoprotein IIb/IIIa receptor antagonist eptifibatide reduced the incidence of death or myocardi al infarction among patients with acute ischemic syndromes without ST-segme nt elevation. Because of expected differences in practice patterns, a prosp ective planned analysis of outcomes as a function of regions of the world w as performed. The current study provides a detailed assessment of eptifibat ide among the subgroup of patients enrolled within the United States. Methods and Results-Patients presenting with chest pain within the previous 24 hours and ischemic ECG changes or creatine kinase-MB elevation were eli gible for enrollment. Of the 10 948 patients randomized worldwide, 4035 wer e enrolled within the United States. Patients were allocated to placebo or eptifibatide infusion for up to 72 to 96 hours. Other medical therapies and revascularization strategies were at the discretion of the treating physic ian. Eptifibatide reduced the rate of the primary end point of death or myo cardial infarction by 30 days from 15.4% to 11.9% (P=0.003) among patients in the United States, The treatment effect was achieved early and maintaine d over a period of 6 months (18.9% versus 15.2%; P=0,004). Bleeding events were more common in patients receiving eptifibatide but were predominantly associated with invasive procedures. The magnitude of clinical benefit from eptifibatide was greater among patients in the United States than elsewher e in the world. Conclusions-Platelet glycoprotein IIb/IIIa receptor blockade with eptifibat ide reduces the incidence of death or myocardial infarction among patients treated for acute ischemic syndromes without ST-segment elevation within th e United States.