Differential treatment benefit of platelet glycoprotein IIb/IIIa inhibition with percutaneous coronary intervention versus medical therapy for acute coronary syndromes: exploration of methods.
BACKGROUND
Although many believe that platelet glycoprotein IIb/IIIa inhibitors should be used only in acute coronary syndrome patients undergoing percutaneous coronary intervention, supporting data from randomized clinical trials are tenuous. The assumption that these agents are useful only in conjunction with percutaneous coronary intervention is based primarily on inappropriate subgroup analyses performed across the glycoprotein IIb/IIIa inhibitor trials.


RESULTS
We describe the problems with these analytical techniques and demonstrate that different approaches to the question can result in opposing answers.


CONCLUSIONS
Clinical-practice decisions and practice guidelines should be based on overall trial results and not analyses of post-randomization subgroups.
Pieper
Karen S
KS
Duke Clinical Research Institute and Department of Medicine, Duke University Medical Center, Durham, NC 27715, USA. karen.pieper@duke.edu
Tsiatis
Anastasios A
AA
Davidian
Marie
M
Hasselblad
Vic
V
Kleiman
Neal S
NS
Boersma
Eric
E
Chang
Wei-Ching
WC
Griffin
Jeffrey
J
Armstrong
Paul W
PW
Califf
Robert M
RM
Harrington
Robert A
RA
D000208:Acute Disease; D000368:Aged; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D018579:Patient Selection; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013577:Syndrome; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex