title: Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. PURSUIT Investigators.
abstract: 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.
  
  
  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.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA. kleiman@bcm.tmc.edu
authors.forename: N S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: A M
authors.initials: AM
authors.lastname: Lincoff
authors.forename: G C
authors.initials: GC
authors.lastname: Flaker
authors.forename: K S
authors.initials: KS
authors.lastname: Pieper
authors.forename: R G
authors.initials: RG
authors.lastname: Wilcox
authors.forename: L G
authors.initials: LG
authors.lastname: Berdan
authors.forename: T J
authors.initials: TJ
authors.lastname: Lorenz
authors.forename: D V
authors.initials: DV
authors.lastname: Cokkinos
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: R A
authors.initials: RA
authors.lastname: Harrington
mesh_terms: D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide