Therapeutic adjuncts for immediate transfer to the catheterization laboratory in patients with acute coronary syndromes

Early coronary intervention in patients with non-ST-segment elevation myoca rdial infarction (MI) and unstable angina may be made safer and more effica cious with concomitant therapies, including glycoprotein IIb/IIIa inhibitor s and low-molecular-weight heparins. Stent placement has been shown to impr ove procedural success and reduce major in-hospital complications when comp ared with balloon angioplasty alone in patients with unstable angina. Howev er, unstable angina remains a major hazard for adverse coronary events in l ong-term follow-up after elective stent placement. The currently available glycoprotein IIb/IIIa inhibitors-eptifibatide, tirofiban, and abciximab-hav e each been shown to reduce ischemic events before percutaneous coronary in tervention when administered to patients presenting with non-ST-segment ele vation acute coronary syndromes in large clinical trials. The adjunctive ro le of low-molecular-weight heparins in this scenario has been largely unexp lored. Enoxaparin, when given before angiography or percutaneous coronary i ntervention, has been shown to be superior to unfractionated heparin in pre venting major coronary events. In this review, an algorithm for treatment o f non-ST-segment elevation acute coronary syndromes is presented and the cu rrent role of these newer adjunctive pharmacotherapies is explored. In the future, combinations of these agents may prove to be most beneficial in pat ients undergoing early percutaneous coronary intervention. (C) 2000 by Exce rpta Medica, Inc.