BACKGROUND: Glycoprotein (GP) IIb/IIIa receptor blockers prevent
life-threatening cardiac complications in patients with acute coronary
syndromes without ST-segment elevation and protect against thrombotic
complications associated with percutaneous coronary interventions (PCIs).
The question arises as to whether these 2 beneficial effects are
independent and additive. METHODS AND RESULTS: We analyzed data from the
CAPTURE, PURSUIT, and PRISM-PLUS randomized trials, which studied the
effects of the GP IIb/IIIa inhibitors abciximab, eptifibatide, and
tirofiban, respectively, in acute coronary syndrome patients without
persistent ST-segment elevation, with a period of study drug infusion
before a possible PCI. During the period of pharmacological treatment,
each trial demonstrated a significant reduction in the rate of death or
nonfatal myocardial infarction in patients randomized to the GP IIb/IIIa
inhibitor compared with placebo. The 3 trials combined showed a 2.5% event
rate in this period in the GP IIb/IIIa inhibitor group (N=6125) versus
3.8% in placebo (N=6171), which implies a 34% relative reduction
(P<0.001). During study medication, a PCI was performed in 1358 patients
assigned GP IIb/IIIa inhibition and 1396 placebo patients. The event rate
during the first 48 hours after PCI was also significantly lower in the GP
IIb/IIIa inhibitor group (4. 9% versus 8.0%; 41% reduction; P<0.001). No
further benefit or rebound effect was observed beyond 48 hours after the
PCI. CONCLUSIONS: There is conclusive evidence of an early benefit of GP
IIb/IIIa inhibitors during medical treatment in patients with acute
coronary syndromes without persistent ST-segment elevation. In addition,
in patients subsequently undergoing PCI, GP IIb/IIIa inhibition protects
against myocardial damage associated with the intervention