VIEWPOINT
Glycoprotein IIb/IIIa inhibition in the setting of acute ST-segment elevation myocardial infarction
Mark J. Eisenberg, MD, MPH*,* and
Shelina Jamal, BSc*
* Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Manuscript received December 13, 2002;
revised manuscript received March 26, 2003,
accepted April 10, 2003.
* Reprint requests and correspondence: Dr. Mark J. Eisenberg, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote Ste. Catherine Road/Suite A-118, Montreal, Quebec H3T 1E2, Canada.
marke{at}epid.jgh.mcgill.ca
Glycoprotein (GP) IIb/IIIa inhibitors have been extensively studied in the setting of percutaneous coronary intervention (PCI) and in the management of non–ST-segment elevation acute coronary syndromes. However, the use of GP IIb/IIIa inhibitors is less well established in the setting of acute ST-segment elevation myocardial infarction (MI). Multiple nonrandomized studies suggest that combination therapy with GP IIb/IIIa inhibitors and thrombolytic agents leads to increased rates of TIMI 3 flow. However, two clinical trials involving over 22,000 patients demonstrated that combination therapy is associated with only modest reductions in major adverse cardiac events, does not reduce mortality, and is associated with an increase in bleeding. In the setting of primary PCI, four clinical trials involving over 3,000 patients demonstrated that GP IIb/IIIa inhibition results in a significant decrease in the need for urgent target vessel revascularization but not in reductions of death or recurrent MI. Thus, GP IIb/IIIa inhibition may provide only limited benefits in the setting of acute ST-segment elevation MI.
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Abbreviations and Acronyms
| | ADMIRAL | = Abciximab Before Direct Angioplasty and Stenting in MI Regarding Acute and Long-term Follow-up | | ASSENT-III | = Assessment of the Safety and Efficacy of a New Thrombolytic-III | | CADILLAC | = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications | | GP | = glycoprotein | | GUSTO-V | = Global Utilization of Strategies to open Occluded Coronary Arteries-V | | IMPACT-AMI | = Integrelin to Manage Platelet Aggregation to Combat Thrombosis in Acute Myocardial Infarction | | INTRO AMI | = Integrelin and Reduced-dose Thrombolytics in Acute Myocardial Infarction | | ISAR-2 | = Intracoronary Stenting and Antithrombotic Regimen-2 | | MI | = myocardial infarction | | PCI | = percutaneous coronary intervention | | RAPPORT | = Reopro in Acute Myocardial Infarction and Primary PTCA Organization and Randomized Trial | | SPEED | = Strategies for Patency Enhancement in the Emergency Department | | TIMI | = Thrombolysis In Myocardial Infarction |
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