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