title: Outcomes with the use of glycoprotein IIb/IIIa inhibitors in non-ST-segment elevation acute coronary syndromes.
abstract: 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.
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, 365 Plantation Street, Suite 185, Worcester, MA 01605, USA. omar.dabbous@gmail.com
authors.forename: O H
authors.initials: OH
authors.lastname: Dabbous
authors.forename: F A
authors.initials: FA
authors.lastname: Anderson
authors.forename: J M
authors.initials: JM
authors.lastname: Gore
authors.forename: K A
authors.initials: KA
authors.lastname: Eagle
authors.forename: K A A
authors.initials: KA
authors.lastname: Fox
authors.forename: R H
authors.initials: RH
authors.lastname: Mehta
authors.forename: R J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: G
authors.initials: G
authors.lastname: Agnelli
authors.forename: P G
authors.initials: PG
authors.lastname: Steg
mesh_terms: 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
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex