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(Circulation. 2000;102:1093.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Management of Patients With Acute Coronary Syndromes in the United States by Platelet Glycoprotein IIb/IIIa Inhibition

Insights From the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial

A. Michael Lincoff, MD; Robert A. Harrington, MD; Robert M. Califf, MD; Judith S. Hochman, MD; Alan D. Guerci, MD; E. Magnus Ohman, MD; Carl J. Pepine, MD; Steven L. Kopecky, MD; Neal S. Kleiman, MD; Cynthia M. Pacchiana, MS; Lisa G. Berdan, PA-C, MHS; Michael M. Kitt, MD; Maarten L. Simoons, MD; Eric J. Topol, MD; for the PURSUIT Trial Investigators¹

From the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio (A.M.L., E.J.T.); Duke Clinical Research Institute, Durham, NC (R.A.H., R.M.C., E.M.O., C.M.P., L.G.B.); St Lukes–Roosevelt Hospital Center, New York, NY (J.S.H.); St Francis Hospital, Roslyn, NY (A.D.G.); University of Florida, Gainesville (C.J.P.); Mayo Clinic and Foundation, Rochester, Minn (S.L.K.); COR Therapeutics, South San Francisco, Calif (M.M.K.); and Cardialysis, Thoraxcenter, Rotterdam, The Netherlands (M.L.S.).

Correspondence to A. Michael Lincoff, MD, Department of Cardiology, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

Background—A multinational, randomized, placebo-controlled trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, PURSUIT) demonstrated that the platelet glycoprotein IIb/IIIa receptor antagonist eptifibatide reduced the incidence of death or myocardial infarction among patients with acute ischemic syndromes without ST-segment elevation. Because of expected differences in practice patterns, a prospectively planned analysis of outcomes as a function of regions of the world was performed. The current study provides a detailed assessment of eptifibatide among the subgroup of patients enrolled within the United States.

Methods and Results—Patients presenting with chest pain within the previous 24 hours and ischemic ECG changes or creatine kinase–MB elevation were eligible for enrollment. Of the 10 948 patients randomized worldwide, 4035 were enrolled within the United States. Patients were allocated to placebo or eptifibatide infusion for up to 72 to 96 hours. Other medical therapies and revascularization strategies were at the discretion of the treating physician. Eptifibatide reduced the rate of the primary end point of death or myocardial infarction by 30 days from 15.4% to 11.9% (P=0.003) among patients in the United States. The treatment effect was achieved early and maintained over a period of 6 months (18.9% versus 15.2%; P=0.004). Bleeding events were more common in patients receiving eptifibatide but were predominantly associated with invasive procedures. The magnitude of clinical benefit from eptifibatide was greater among patients in the United States than elsewhere in the world.

Conclusions—Platelet glycoprotein IIb/IIIa receptor blockade with eptifibatide reduces the incidence of death or myocardial infarction among patients treated for acute ischemic syndromes without ST-segment elevation within the United States.

Key Words: platelets • angina • myocardial infarction • angioplasty • glycoproteins

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