Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease
A. Michael Lincoff, MD, FACC*,
Robert M. Califf, MD, FACC and
Eric J. Topol, MD, FACC*
* Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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Figure 1 Composite 30-day end point (death, myocardial infarction or urgent repeat revascularization) event rates for the seven glycoprotein IIb/IIIa interventional trials. This was not the prespecified primary end point of RESTORE or RAPPORT. RESTORE trial end points listed here are for the published post-hoc analysis including only urgent repeat revascularization. RESTORE trial end points listed here differ from those of the other trials in that only patients with successful crossing of the lesion with the guidewire were included in the efficacy analysis of RESTORE, whereas all randomized patients were included in the other studies. RAPPORT trial end points listed here are for secondary end point of death, myocardial infarction or urgent repeat target vessel revascularization. *EPISTENT trial groups compared with reference group of Placebo + Stent; thus, the "placebo control" for the Abciximab + PTCA group underwent stenting rather than PTCA. B = bolus; B + I = bolus plus infusion; CAPTURE = C7E3 AntiPlatelet Therapy in Unstable REfractory angina; EPIC = Evaluation of c7E3 for Prevention of Ischemic Complications; EPILOG = Evaluation in PTCA to Improve Long-term Outcome with abciximab GP IIb/IIIa blockade; EPISTENT = Evaluation of Platelet Inhibition in STENTing; IMPACT = Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis; LDH = low-dose, weight-adjusted heparin; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty; RAPPORT = ReoPro And Primary PTCA Organization and Randomized Trial; RESTORE = Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis; SDH = standard-dose, weight-adjusted heparin; 135/.5 and 135/.75 = eptifibatide doses: 135 µg/kg bolus, followed by infusions of 0.5 or 0.75 µg/kg-min.
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Figure 2 Composite six-month end point of death or myocardial (re-) infarction event rates for the glycoprotein IIb/IIIa interventional trials. *EPISTENT trial groups compared with reference group of Placebo + Stent. Abbreviations as in Figure 1.
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Figure 3 Rates of in-hospital Thrombolysis in Myocardial Infarction (TIMI) major bleeding in the glycoprotein IIb/IIIa interventional trials. *EPISTENT trial groups compared with reference group of Placebo + Stent. Major bleeding defined as intracranial hemorrhage or a fall in hemoglobin by  5 mg/dl (57). Abbreviations as in Figure 1.
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Figure 4 Composite 30-day composite end point of death or myocardial (re-) infarction in the four glycoprotein IIb/IIIa unstable ischemic syndrome trials. Efficacy data are not provided for the low-dose eptifibatide group PURSUIT and the tirofiban plus placebo group PRISM PLUS treatment arms, which were discontinued before completion of the trials. *p = 0.03 in PRISM PLUS did not reach the prespecified level of p = 0.025 for a three group trial; Heparin use in PURSUIT was encouraged, but not mandated, and was administered to 89.9% and 89.7% of patients randomized to placebo and eptifibatide, respectively. PARAGON = Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome events in the Global Organization Network; PRISM PLUS = Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs; PURSUIT = Platelet IIb/IIIa in Unstable Angina: Receptor Supression Using Integrilin Therapy.
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