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(Circulation. 2001;103:2891.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Benefit of Glycoprotein IIb/IIIa Inhibition in Patients With Acute Coronary Syndromes and Troponin T–Positive Status
The PARAGON-B Troponin T Substudy
From the Duke Clinical Research Institute, Durham, NC (L.K.N., E.M.O., R.A.H., V.H., R.M.C.); University of Maryland Medical System, Baltimore (R.H.C.); Cleveland Clinic Foundation, Cleveland, Ohio (D.J.M., E.J.T.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); University of Alberta, Edmonton, Canada (P.W.A.); Catholic University Hospital, Leuven, Belgium (F.V.d.W.); and University Hospital, Basel, Switzerland (M.P.).
Correspondence to L. Kristin Newby, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail newby001{at}mc.duke.edu
Background—Troponin T (TnT) is valuable for short- and long-term risk stratification of patients with acute coronary syndromes (ACS). It also may predict which ACS patients will benefit from glycoprotein (GP) IIb/IIIa blockade.
Methods and Results—We
prospectively studied 1160 patients with non–ST-segment elevation ACS
randomized in PARAGON-B to receive lamifiban, an
intravenous GP IIb/IIIa antagonist, or placebo.
TnT levels were obtained before study treatment began and 24 to 72
hours later; assays were performed by a blinded core laboratory. At
baseline, 40.2% of patients were TnT-positive (
0.1 ng/mL); these
patients were older and more often male or smokers. Patients positive
at baseline had a significantly higher rate of the primary end point
(composite of death, myocardial [re]infarction, or severe recurrent
ischemia at 30 days; odds ratio, 1.5; 95% CI, 1.1 to 2.1) than
those who were TnT-negative. Lamifiban was associated with significant
reduction in the primary end point (from 19.4% to 11.0%,
P=0.01) among TnT-positive
patients but not among TnT-negative patients (11.2% for placebo versus
10.8% for lamifiban, P=0.86;
P=0.08 for test of interaction
between TnT status and treatment assignment). This pattern held for the
end points of death alone and death or myocardial (re)infarction at 30
days. Peak TnT level at 48 hours did not differ with lamifiban
treatment.
Conclusions—TnT predicts poor short-term outcomes in non–ST-segment elevation ACS. Treatment benefit with lamifiban is limited almost exclusively to TnT-positive patients, reducing 30-day adverse outcomes to a rate nearly identical to that of negative patients.
Key Words: coronary disease • troponins • prognosis • platelets • inhibitors
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|
|
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|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|