Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: patient selection and associated treatment patterns.
OBJECTIVE
The authors analyzed contemporary use of glycoprotein (GP) IIb/IIIa inhibitors in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) to determine patient selection patterns with early (<24 hours) GP IIb/IIIa inhibitor use and the relationship between GP IIb/IIIa inhibitor therapy and use of other guidelines-recommended therapies for NSTE ACS.


METHODS
Using the CRUSADE Quality Improvement Initiative database, patient characteristics, in-hospital treatments, and outcomes for 65,424 patients with ischemic chest pain of <24 hours' duration and either positive cardiac markers or ischemic electrocardiographic changes were analyzed. Data were collected from 443 U.S. hospitals from January 2001 to June 2003.


RESULTS
Only 35% of eligible patients received GP IIb/IIIa inhibitors <24 hours after hospital admission. Approximately one third of patients received GP IIb/IIIa inhibitors in the emergency department, one third in the coronary care unit, and one third in the catheterization laboratory. Admission to a cardiologist's care was the most significant associated factor with early GP IIb/IIIa inhibitor use, along with elevated cardiac markers or ST-segment deviation. Patients at high risk for adverse cardiac events due to advanced age, congestive heart failure, or female gender were less likely to receive early GP IIb/IIIa inhibitor therapy. Patients who received early GP IIb/IIIa inhibitor therapy were more likely to receive other guidelines-recommended therapies.


CONCLUSIONS
Despite the American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommendations, early GP IIb/IIIa inhibitor therapy remains underutilized in patients with NSTE ACS and administration of early GP IIb/IIIa inhibitors is directed toward lower-risk patients. Early GP IIb/IIIa inhibitor therapy is associated with improved overall adherence to the ACC/AHA guidelines.
Hoekstra
James W
JW
Department of Emergency Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA. jhoekstr@wfubmc.edu
Roe
Matthew T
MT
Peterson
Eric D
ED
Menon
Venu
V
Mulgund
Jyotsna
J
Pollack
Charles V
CV
Miller
Chadwick
C
Palabrica
Theresa
T
Harrington
Robert A
RA
Ohman
E Magnus
EM
Gibler
W Brian
WB
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002309:Cardiology / Q000706:statistics & numerical data; D002637:Chest Pain / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States
D015415:Biomarkers; D019039:Platelet Glycoprotein GPIIb-IIIa Complex