CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION
Early use of glycoprotein IIb/IIIa inhibitors in non–ST-elevation acute myocardial infarction
Observations from the National Registry of Myocardial Infarction 4
Eric D. Peterson, MD, MPH*,*,
Charles V. Pollack, Jr, MD, MA ,
Matthew T. Roe, MD, MHS*,
Lori S. Parsons, BS ,
Katherine A. Littrell, PhD, RN ,
John G. Canto, MD, MSPH, FACC||,
Hal V. Barron, MD National Registry of Myocardial Infarction (NRMI) 4 Investigators
* Duke Clinical Research Institute, Durham, North Carolina, USA
University of Pennsylvania, Philadelphia, Pennsylvania, USA
Ovation Research, Highland Park, Illinois, USA
Genentech, Inc., San Francisco, California, USA
|| University of Alabama, Birmingham, Alabama, USA
Manuscript received June 13, 2002;
revised manuscript received December 16, 2002,
accepted December 18, 2002.
* Reprint requests and correspondence: Dr. Eric D. Peterson, Duke Clinical Research Institute, 2400 Pratt Street, Room 7009, Durham, North Carolina 27705, USA.
peter016{at}mc.duke.edu
OBJECTIVES: We sought to identify patient and hospital features associated with early glycoprotein (GP) IIb/IIIa inhibitor therapy for non–ST-elevation (NSTE) myocardial infarction (MI) and to relate this treatment to in-hospital outcomes.
BACKGROUND: Glycoprotein IIb/IIIa inhibitors have improved outcomes in randomized trials of NSTE MI, leading national treatment guidelines to recommend their use. Their actual use, safety, and effectiveness have not been well characterized beyond trial populations.
METHODS: We studied 60,770 patients with NSTE MI treated between July 2000 and July 2001 at 1,189 hospitals in a U.S. registry. Using logistic regression, we identified patient and hospital features associated with GP IIb/IIIa inhibition within 24 h after presentation. We also compared outcomes by early treatment versus no treatment after adjusting for patient and hospital characteristics and treatment propensity.
RESULTS: Only 25% of eligible patients received early GP IIb/IIIa therapy. Elderly patients, women, minority patients, and those without private insurance received such therapy less often than their counterparts. Treated patients had lower unadjusted in-hospital mortality (3.3% vs. 9.6%, p < 0.0001) remaining significantly lower after adjustment for patient risk, treatment propensity, and hospital characteristics (adjusted odds ratio, 0.88; 95% confidence interval, 0.79 to 0.97). Hospitals that adopted early GP IIb/IIIa inhibition more rapidly also had lower adjusted mortality rates than those slower to adopt such therapy.
CONCLUSIONS: Glycoprotein IIb/IIIa inhibitor therapy appears to be underused in early management of NSTE MI patients. Because this therapy is associated with better outcomes, it represents a target for quality improvement.
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Abbreviations and Acronyms
| | ACC | | American College of Cardiology | | ACE | | angiotensin-converting enzyme | | AHA | | American Heart Association | | CK | | creatine kinase | | GP | | glycoprotein | | GUSTO IV ACS | | Effect of Glycoprotein IIb/IIIa Receptor Blocker Abciximab on Outcome in Patients with Acute Coronary Syndromes without Early Coronary Revascularization | | MI | | myocardial infarction | | NRMI | | National Registry of Myocardial Infarction | | NSTE | | non–ST-elevation | | OR | | odds ratio | | PCI | | percutaneous coronary intervention |
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