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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.

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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