title: Early angioplasty in acute coronary syndromes without persistent ST-segment elevation improves outcome but increases the need for six-month repeat revascularization: an analysis of the PURSUIT Trial. Platelet glycoprotein IIB/IIIA in Unstable angina: Receptor Suppression Using Integrilin Therapy.
abstract: OBJECTIVE
  We explored the effect of timing of percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) without persistent ST-segment elevation on the need for repeat revascularization, and we related this effect to other events.
  
  
  BACKGROUND
  Percutaneous coronary intervention is widely used to treat ACS without persistent ST-segment elevation. Moreover, restenosis and subsequent revascularization after PCI are more frequent in ACS than in stable angina. The optimal timing of PCI in ACS without persistent ST-segment elevation is unknown.
  
  
  METHODS
  In the Platelet glycoprotein IIB/IIIA in Unstable angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) database, patients were stratified by the time of PCI. In the PURSUIT trial, 9,461 patients received a platelet glycoprotein IIb/IIIa inhibitor, eptifibatide or placebo for 72 h. The investigators decided on other treatments.
  
  
  RESULTS
  A total of 2,430 patients underwent PCI within 30 days. Repeat revascularization (during 165 days) was notably higher for PCI within 24 h of enrollment (n = 620 [19%]) than for PCI at 24 to 72 h (n = 624 [16.7%]), 3 to 7 days (n = 614 [13.2%]), or 8 to 30 days (n = 561 [7.7%]; p < 0.001), regardless of eptifibatide use. This gradual reduction in the revascularization rate for later PCI was also observed after multivariate analysis correcting for baseline characteristics and with time as a continuous variable.
  
  
  CONCLUSIONS
  Percutaneous coronary intervention within 24 is associated with improved outcome (other analysis) but more repeat revascularization. Prospective analyses are needed to test the hypothesis that rapid PCI in ACS with a platelet glycoprotein IIb/IIIa receptor antagonist reduces myocardial infarction (and possibly death) and is therefore most suited for patients at highest risk of infarction, despite a higher need for repeat revascularization.
authors.affiliation: University Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Eelko
authors.initials: E
authors.lastname: Ronner
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Laarman
authors.forename: G Aernout
authors.initials: GA
authors.lastname: Somsen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome