Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation

OBJECTIVES The study examined whether antiplatelet treatment with eptifibat ide affected the frequency and outcome of shock among patients in the Plate let Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using In tegrilin Therapy (PURSUIT) trial who had acute coronary syndromes but not p ersistent ST-segment elevation. BACKGROUND Preliminary reports suggest a sa lutary effect of antiplatelet agents when shock complicates acute myocardia l infarction. METHODS We analyzed the impact of antiplatelet treatment with eptifibatide on the frequency and outcome of cardiogenic shock developing after enrollme nt. PURSUIT was a double-blind, randomized trial that examined the efficacy of eptifibatide (180 mu g/kg bolus + continuous infusion of 2.0 mu g/kg/mi n for less than or equal to 96 h) versus placebo among patients who had acu te coronary syndromes but not persistent ST-segment elevation. RESULTS Shock developed in 2.5% of the 9,449 patients at a median (25th, 75 th interquartiles) of 94.0 (38, 206) h. Death by 30 days occurred in 65.8% of shock patients. Patients who had acute myocardial infarction upon enroll ment had a greater incidence of shock (2.9% vs. 2.1%, p = 0.01), developed shock earlier (40.2% <48 h vs. 20.9%, p = 0.001), and had higher 30-day mor tality from shock (77.2% vs. 52.7%, p = 0.001). Randomization to eptifibati de did not affect the occurrence of shock (p = 0.71, adjusted odds ratio [O R] = 0.95, 95% confidence interval [CI] = 0.72-1.25). However, shock patien ts treated with eptifibatide had significantly reduced adjusted odds of 30- day death (p = 0.03, adjusted OR = 0.51, 95% CI = 0.28-0.94). CONCLUSIONS Patients with shock treated with eptifibatide had significantly reduced adjusted odds of death, suggesting a salutary effect of antiplatel et therapy on shock. This finding warrants verification in specifically des igned studies. (C) 2000 by the American College of Cardiology.