7 research outputs found
Stroke in Patients With Acute Coronary Syndromes: Incidence and Outcomes in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial
BACKGROUND: The incidence of stroke in patients with acute coronary
syndromes has not been clearly defined because few trials in this patient
population have been large enough to provide stable estimates of stroke
rates. METHODS AND RESULTS: We studied the 10 948 patients with acute
coronary syndromes without persistent ST-segment elevation who were
randomly assigned to placebo or the platelet glycoprotein IIb/IIIa
receptor inhibitor eptifibatide in the Platelet Glycoprotein IIb/IIIa in
Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT)
trial to determine stroke rates, stroke types, clinical outcomes in
patients with stroke, and independent baseline clinical predictors for
nonhemorrhagic stroke. Stroke occurred in 79 (0.7%) patients, with 66
(0.6%) nonhemorrhagic, 6 intracranial hemorrhages, 3 cerebral infarctions
with hemorrhagic conversion, and 4 of uncertain cause. There were no
differences in stroke rates between patients who received placebo and
those assigned high-dose eptifibatide (odds ratios and 95% confidence
intervals 0.82 [0.59, 1.14] and 0.70 [0.49, 0.99], respectively). Of the
79 patients with stroke, 17 (22%) died within 30 days, and another 26
(32%) were disabled by hospital discharge or 30 days, whichever came
first. Higher heart rate was the most important baseline clinical
predictor of nonhemorrhagic stroke, followed by older age, prior anterior
myocardial infarction, prior stroke or transient ischemic attack, and
diabetes mellitus. These factors were used to develop a simple scoring
nomogram that can predict the risk of nonhemorrhagic stroke. CONCLUSIONS:
Stro
Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. PURSUIT Investigators
BACKGROUND: Platelet glycoprotein (GP) IIb/IIIa antagonists prevent the
composite end point of death or myocardial infarction (MI) in patients
with acute coronary syndromes. There is uncertainty about whether this
effect is confined to patients who have percutaneous coronary
interventions (PCIs) and whether PCIs further prevent death or MI in
patients already treated with GP IIb/IIIa antagonists. METHODS AND
RESULTS: PURSUIT patients were treated with the GP IIb/IIIa antagonist
eptifibatide or placebo; PCIs were performed according to physician
practices. In 2253 of 9641 patients (23.4%), PCI was performed by 30 days.
Early (<72 hours) PCI was performed in 1228 (12.7%). In 34 placebo
patients (5.5%) and 10 treated with eptifibatide (1.7%) (P=0.001), MI
preceded early PCI. In patients censored for PCI across the 30-day period,
there was a significant reduction in the primary composite end point in
eptifibatide patients (P=0.035). Eptifibatide reduced 30-day events in
patients who had early PCI (11.6% versus 16.7%, P=0.01) and in patients
who did not (14.6% versus 15.6%, P=0.23). After adjustment for PCI
propensity, there was no evidence that eptifibatide treatment effect
differed between patients with or without early PCI (P for
interaction=0.634). PCI was not associated with a reduction of the primary
composite end point but was associated with a reduced (nonspecified)
composite of death or Q-wave MI. This association disappeared after
adjustment for propensity for early PCI. CONCLUSIONS: Eptifibatide reduced
the composite rates of death or MI in PCI patients and those managed
conservatively
A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease
BACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with balloon angioplasty, which relies on dilation of the plaque and vessel wall. We compared the rate of restenosis after angioplasty with that after atherectomy. METHODS. At 35 sites in the United States and Europe, 1012 patients were randomly assigned to either atherectomy (512 patients) or angioplasty (500 patients). The patients underwent coronar