Outcomes with the use of glycoprotein IIb/IIIa inhibitors in non-ST-segment elevation acute coronary syndromes.
OBJECTIVE
To compare the characteristics, management, and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who would have been eligible for inclusion in clinical trials of glycoprotein (GP) IIb/IIIa inhibitors with those of ineligible patients.


METHODS
Multinational, prospective, observational study (GRACE, Global Registry of Acute Coronary Events).


METHODS
Patients hospitalised for a suspected acute coronary syndrome and enrolled in GRACE between April 1999 and December 2004.


METHODS
29 039 patients with NSTE ACS.


METHODS
Characteristics and outcomes were compared for trial-eligible (75.0%) and trial-ineligible (25.0%) patients.


RESULTS
GP IIb/IIIa inhibitors were administered to 20.0% of eligible and 15.3% of ineligible patients. Compared with eligible patients, ineligible patients who received GP IIb/IIIa inhibitors had significantly higher rates of hospital death (6.8% vs 3.7%) and major bleeding (4.9% vs 2.2%). After adjustment for their higher baseline risk, ineligible patients still experienced higher hospital death rates (adjusted odds ratio (OR) 1.60; 95% confidence interval (CI) 1.01 to 2.39), but not higher bleeding rates, than the eligible group. Use of GP IIb/IIIa inhibitors was associated with a trend towards lower 6-month mortality in eligible (OR 0.86, 95% CI 0.72 to 1.02) and ineligible (OR 0.82, 95% CI 0.65 to 1.05) patients compared with those in whom this therapy was not used.


CONCLUSIONS
GP IIb/IIIa inhibitors were markedly underused in the real-world population, irrespective of whether patients were trial-eligible or not. Despite the higher risk of ineligible patients, the benefits of GP IIb/IIIa inhibitors appear to be no less than in eligible patients.
Dabbous
O H
OH
Center for Outcomes Research, University of Massachusetts Medical School, 365 Plantation Street, Suite 185, Worcester, MA 01605, USA. omar.dabbous@gmail.com
Anderson
F A
FA
Gore
J M
JM
Eagle
K A
KA
Fox
K A A
KA
Mehta
R H
RH
Goldberg
R J
RJ
Agnelli
G
G
Steg
P G
PG
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex