Management of patients with non-ST-segment elevation acute coronary syndromes: Insights from the PURSUIT trial

The glycoprotein (GP) IIb-IIIa inhibitor eptifibatide (INTEGRILIN(R), COR T herapeutics, Inc., South San Francisco, California, and Key Pharmaceuticals , Inc., Kenilworth, New Jersey) is a novel and highly potent antithrombotic agent indicated for the management of patients with non-ST-segment elevati on acute coronary syndromes (ACS) and those undergoing percutaneous coronar y intervention. The approval of eptifibatide for non-ST-segment elevation A CS was based on the positive results of the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. With enrollment of almost 11,000 patients, not only is the PURSUIT trial the largest trial of a CP IIb-IIIa inhibitor to date, but it is also the largest clinical study ever conducted in patients with non-ST-segment e levation ACS. The key feature of the PURSUIT trial is that patient manageme nt closely resembled standard clinical practice, because decisions about th e use and timing of invasive cardiac procedures were made by the individual physicians rather than being prespecified in the study protocol. Eptifibat ide therapy was associated with a significant reduction in the incidence of the primary endpoint-a composite of death or myocardial infarction at 30 d ays (14.2 vs. 15.7% in the placebo group; p = 0.042). Of importance is the fact that the beneficial effect of eptifibatide was independent of the mana gement strategy pursued during study drug infusion (invasive or conservativ e), and it was achieved with few major safety concerns. These findings demo nstrate that the use of eptifibatide should be considered for all patients presenting with signs and symptoms of intermediate- to high-risk non-ST-seg ment elevation ACS.