CLINICAL STUDY: ACUTE CORONARY SYNDROMES
Therapeutic value of eptifibatide at community hospitals transferring patients to tertiary referral centers early after admission for acute coronary syndromes
Adam B. Greenbaum, MD*,
Robert A. Harrington, MD*,
Michael P. Hudson, MD*,
Cynthia M. MacAulay, MS*,
Robert G. Wilcox, MD ,
Maarten L. Simoons, MD, FACC ,
Lisa G. Berdan, PA-C, MHS*,
Alan Guerci, MD, FACC ,
Dennis V. Cokkinos, MD, FACC||,
Michael M. Kitt, MD¶,
A. Michael Lincoff, MD, FACC#,
Eric J. Topol, MD, FACC#,
Robert M. Califf, MD, FACC*,
E. Magnus Ohman, MD, FACC* for the PURSUIT Investigators
* Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
Queen’s Medical Centre, Nottingham, England, UK
Erasmus University, Rotterdam, The Netherlands
St. Francis Hospital, Roslyn, New York, USA
|| Onassis Cardiac Surgery Center, Athens, Greece
¶ Cor Therapeutics, San Francisco, California, USA
# the Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received May 6, 1999;
revised manuscript received September 11, 2000,
accepted October 16, 2000.
Reprint requests and correspondence: Dr. Adam B. Greenbaum, Henry Ford Hospital, K-2 Cardiac Catheterization Laboratory, 2799 West Grand Boulevard, Detroit, Michigan 48202
agreenb1{at}hfhs.org
OBJECTIVES
We aimed to evaluate the benefits of the glycoprotein (GP) IIb/IIIa antagonist, eptifibatide, after patients with acute coronary syndromes (ACS) were admitted to hospitals that approach revascularization for ACS through early transfer to tertiary referral centers.
BACKGROUND
Across a variety of hospital settings, GP IIb/IIIa inhibition, after patients were admitted to the hospital for non-ST segment elevation ACS, is 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 Platelet glycoprotein IIb/IIIa in unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, who were transferred during study drug infusion ("transfer patients"), were compared with those of 1,987 patients who either remained in the hospital at those sites or were transferred after study drug termination ("nontransfer patients").
RESULTS
The baseline characteristics of transfer and nontransfer patients were similar. Patients receiving eptifibatide were transferred less frequently than those receiving placebo (16% vs. 20%, p = 0.014). Transfer patients underwent more procedures and experienced a greater 30-day incidence of death or MI, as compared with nontransfer patients (21% vs. 12%, p = 0.001). Eptifibatide was associated with a reduction in death or MI through 30 days, independent of transfer status (2.5% absolute reduction), as well as for those transferred (5.5% absolute reduction).
CONCLUSIONS
For patients with ACS admitted to community hospitals, eptifibatide is associated with a reduced need for transfer and improved clinical outcomes.
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Abbreviations and Acronyms
| | ACS | = acute coronary syndromes | | CK-MB | = creatine kinase, myocardial band | | ECG | = electrocardiogram or electrocardiographic | | GP | = glycoprotein | | GUSTO | = Global Utilization of Streptokinase and TPA for Occluded arteries trial | | MI | = myocardial infarction | | PCI | = percutaneous coronary intervention | | PURSUIT | = Platelet glycoprotein IIb/IIIa in unstable angina: Receptor Suppression Using Integrilin Therapy trial | | TIMI | = Thrombolysis In Myocardial Infarction trial |
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