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Glycoprotein IIb/IIIa inhibition in early intent-to-stent treatment of acute coronary syndromes: EPISTENT, ADMIRAL, CADILLAC, and TARGET

^* Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received May 7, 2002; revised manuscript received September 16, 2002, accepted September 25, 2002.

^* Reprint requests and correspondence: Dr. David J. Moliterno, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195, USA.
molited{at}ccf.org

The acute coronary syndromes (ACS), with or without ST-segment elevation, share a common pathophysiology of activated platelets and thrombin generation stimulated by plaque erosion and rupture. Both mechanical and pharmacologic treatment strategies have evolved in an attempt to improve reperfusion at the myocardial tissue level. Intracoronary stents have lowered the incidence of abrupt vessel closure and restenosis, while potent platelet inhibition from intravenous glycoprotein IIb/IIIa antagonists has reduced the rate of periprocedural myocardial infarction and late mortality. Abciximab has well-established clinical benefits in percutaneous revascularization trials, and several recent landmark studies have evaluated the efficacy of concomitant abciximab during mechanical reperfusion therapy in the setting of ACS. These trials are reviewed, and an overall perspective is provided.

Abbreviations and Acronyms   ADP = adenosine diphosphate   ACS = acute coronary syndrome(s)   GP = glycoprotein   HR = hazard ratio   MI = myocardial infarction   PA = plasminogen activator   PCI = percutaneous coronary intervention   TVR = target vessel revascularization

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