Therapeutic value of eptifibatide at community hospitals transferring patients to tertiary referral centers early after admission for acute coronary syndromes

OBJECTIVES We aimed ro evaluate the benefits of the glycoprotein (GP) IIb/I IIa antagonist, eptifibatide, after patients with acute coronary syndromes (ACS) were admitted to hospital that approach revascularization; far ACS th rough early transfer to tertiary referral centers. BACKGROUND Across a variety of hospital settings, GP IIb/IIIa inhibition, a fter patients were admitted to the hospital for non-ST segment elevation AC S, is as associated with a reduction in death or myocardial infarction (MI) before and during a percutaneous coronary intervention. METHODS The outcomes of 429 patients from 153 sites in the Platlet glycopro tein IIb/IIIa in unstable angina: Receptor Suppression Using Integrilin The rapy (PURSUIT) trial who were transferred during study drug infusion ("tran sfer patients"), were compared with those of 1,987 patients who either rema ined in the hospital at those sited or were transferred after study drug te rmination ("nontransfer patients"). RESULTS The baseline characteristics of transfer and nontransfer patients w ere similar. Patients receiving eptifibatide were transferred less frequent ly than those receiving placebo 16% vs. 20%, p = 0.014). Transfer patients underwent more procedures and experienced a greater 30-day incidence of dea th or MI, as compared with nontransfer patients (21% vs. 12%, p = 0.001). E ptifibatide was associated with a reduction in death or MI through 30 days, independent of transfer status (2.5% absolute reduction), as well as for t hose transferred (5.5% absolute reduction). CONCLUSIONS For patients with ACS admitted to community hospitals, eptifiba tide is associated with a reduced need for transfer and improves clinical o utcomes. (C) 2000 by the American College of Cardiology.