This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Labinaz, M. Articles by Harrington, R. A. Search for Related Content PubMed PubMed Citation Articles by Labinaz, M. Articles by Harrington, R. A. Related Collections Platelet function inhibitors CV surgery: coronary artery disease

(Circulation. 2002;105:322.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting

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

Marino Labinaz, MD; Rakhi Kilaru, MSc; Karen Pieper, MSc; Steven P. Marso, MD; Michael M. Kitt, MD; Maarten L. Simoons, MD; Robert M. Califf, MD; Eric J. Topol, MD; Paul W. Armstrong, MD; Robert A. Harrington, MD, for the PURSUIT Investigators

From the University of Ottawa Heart Institute (M.L.), Ottawa, Ontario, Canada; Duke Clinical Research Institute (R.K., K.P., R.A.H., R.M.C.), Durham, NC; Mid America Heart Institute (S.P.M.), Saint Luke’s Hospital, Kansas City, Mo; COR Therapeutics (M.M.K.), South San Francisco, Calif; University Hospital (M.L.S.), Rotterdam, the Netherlands; Cleveland Clinic (E.J.T.), Cleveland, Ohio; and University of Alberta (P.W.A.), Edmonton, Alberta, Canada.

Correspondence to Marino Labinaz, MD, Rm H-150, 40 Ruskin Ave, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada. E-mail mlabinaz{at}ottawaheart.ca

Background— Patients with prior CABG with a subsequent non–ST-segment elevation acute coronary syndrome (ACS) pose an increasingly important clinical problem. Although GP IIb/IIIa inhibitors have improved the outcome of patients with ACS, their efficacy in patients with prior CABG has not been previously evaluated.

Methods and Results— We analyzed the 30- and 180-day outcomes of patients with prior CABG enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. In this trial, which evaluated the efficacy of eptifibatide in patients with ACS, 1134 patients (12%) with prior CABG and 8321 without prior CABG were enrolled. After adjusting for differences in baseline characteristics and treatment, patients with prior CABG had a significantly higher mortality rates at 30 days (hazard ratio [HR], 1.45 [95% CI, 1.06 to 1.98]; P=0.019) and at 180 days (HR, 1.32 [95% CI, 1.04 to 1.67]; P=0.021). At 30 days, there was a similar effect on the primary end point of death or myocardial infarction in the eptifibatide group versus the placebo group in prior CABG patients (unadjusted HR, 0.90 [95% CI, 0.67 to 1.20]) and in patients without a history of CABG (unadjusted HR, 0.89 [95% CI, 0.80 to 0.99]).

Conclusions— Patients with prior CABG with non–ST-segment elevation ACS have a significantly worse prognosis than do patients without a history of CABG. The treatment effect of eptifibatide in the prior CABG group was similar to the effect seen in patients without prior CABG.

Key Words: bypass • platelets • coronary disease • glycoproteins

This article has been cited by other articles:

				C. Berry, K. S. Pieper, H. D. White, S. D. Solomon, F. Van de Werf, E. J. Velazquez, A. P. Maggioni, R. M. Califf, M. A. Pfeffer, and J. J.V. McMurray Patients with prior coronary artery bypass grafting have a poor outcome after myocardial infarction: an analysis of the VALsartan in acute myocardial iNfarcTion trial (VALIANT) Eur. Heart J., June 2, 2009; 30(12): 1450 - 1456. [Abstract] [Full Text] [PDF]

				R. A. Harrington, R. C. Becker, C. P. Cannon, D. Gutterman, A. M. Lincoff, J. J. Popma, G. Steg, G. H. Guyatt, and S. G. Goodman Antithrombotic Therapy for Non-ST-Segment Elevation Acute Coronary Syndromes: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 670S - 707S. [Abstract] [Full Text] [PDF]

				L. Liao, D. F. Kong, L. K. Shaw, M. H. Sketch Jr, C. A. Milano, K. L. Lee, and D. B. Mark A New Anatomic Score for Prognosis After Cardiac Catheterization in Patients with Previous Bypass Surgery J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1684 - 1692. [Abstract] [Full Text] [PDF]

				M. Labinaz, J. Mathias, K. Pieper, C. B. Granger, A. M. Lincoff, D. J. Moliterno, F. Van de Werf, J. Simes, H. D. White, M. L. Simoons, et al. Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials Eur. Heart J., January 2, 2005; 26(2): 128 - 136. [Abstract] [Full Text] [PDF]

				J. A. Gavard, B. R. Chaitman, S. Sakai, K. Stocke, N. Danchin, L. Erhardt, R. Gallo, E. Chi, A. Jessel, and P. Theroux Prognostic significance of elevated creatine kinase MB after coronary bypass surgery and after an acute coronary syndrome: results from the GUARDIAN trial J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 807 - 813. [Abstract] [Full Text] [PDF]