Outcomes of patients with acute coronary syndromes and prior coronary artery bypass grafting: results from the platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (PURSUIT) trial.
BACKGROUND
Patients with prior CABG with a subsequent non-ST-segment elevation acute coronary syndrome (ACS) pose an increasingly important clinical problem. Although GP IIb/IIIa inhibitors have improved the outcome of patients with ACS, their efficacy in patients with prior CABG has not been previously evaluated. Methods and Results- We analyzed the 30- and 180-day outcomes of patients with prior CABG enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. In this trial, which evaluated the efficacy of eptifibatide in patients with ACS, 1134 patients (12%) with prior CABG and 8321 without prior CABG were enrolled. After adjusting for differences in baseline characteristics and treatment, patients with prior CABG had a significantly higher mortality rates at 30 days (hazard ratio [HR], 1.45 [95% CI, 1.06 to 1.98]; P=0.019) and at 180 days (HR, 1.32 [95% CI, 1.04 to 1.67]; P=0.021). At 30 days, there was a similar effect on the primary end point of death or myocardial infarction in the eptifibatide group versus the placebo group in prior CABG patients (unadjusted HR, 0.90 [95% CI, 0.67 to 1.20]) and in patients without a history of CABG (unadjusted HR, 0.89 [95% CI, 0.80 to 0.99]).


CONCLUSIONS
Patients with prior CABG with non-ST-segment elevation ACS have a significantly worse prognosis than do patients without a history of CABG. The treatment effect of eptifibatide in the prior CABG group was similar to the effect seen in patients without prior CABG.
Labinaz
Marino
M
University of Ottawa Heart Institute, Ottawa, Ontario, Canada. mlabinaz@ottawaheart.ca
Kilaru
Rakhi
R
Pieper
Karen
K
Marso
Steven P
SP
Kitt
Michael M
MM
Simoons
Maarten L
ML
Califf
Robert M
RM
Topol
Eric J
EJ
Armstrong
Paul W
PW
Harrington
Robert A
RA
D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D004311:Double-Blind Method; D023381:Endpoint Determination; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D015994:Incidence; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010455:Peptides / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011379:Prognosis; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide