ACUTE CORONARY SYNDROMES

Effects of platelet glycoprotein IIb/IIIa receptor blockers in non-ST segment elevation acute coronary syndromes: benefit and harm in different age subgroups

Adrián V Hernández¹, Cynthia M Westerhout³, Ewout W Steyerberg¹, John P A Ioannidis⁴, Héctor Bueno⁵, Harvey White⁶, Pierre Theroux⁷, David J Moliterno⁸, Paul W Armstrong³, Robert M Califf⁹, Lars C Wallentin¹⁰, Maarten L Simoons², Eric Boersma²

¹ Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
² Clinical Epidemiology Unit, Department of Cardiology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
³ Department of Cardiology, University of Alberta, Edmonton, Alberta, Canada
⁴ Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece
⁵ Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain
⁶ Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
⁷ Department of Cardiology, Montreal Heart Institute, Montreal, Ontario, Canada
⁸ Department of Cardiology, University of Kentucky, Lexington, Kentucky, USA
⁹ Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USA
¹⁰ Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden

Correspondence to:
Dr A V Hernández
Department of Public Health, Center for Medical Decision Making, Erasmus MC-University Medical Centre, Rotterdam, P O Box 2040, 3000 CA, Rotterdam, The Netherlands; adrianhernandezdiaz{at}gmail.com

Objective: To investigate whether the beneficial and harmful effects of platelet glycoprotein IIb/IIIa receptor blockers in non-ST elevation acute coronary syndromes (NSTE-ACS) depend on age.

Methods: A meta-analysis of six trials of platelet glycoprotein IIb/IIIa receptor blockers in patients with NSTE-ACS (PRISM, PRISM-PLUS, PARAGON-A, PURSUIT, PARAGON-B, GUSTO IV-ACS; n = 31 402) was performed. We applied multivariable logistic regression analyses to evaluate the drug effects on death or non-fatal myocardial infarction at 30 days, and on major bleeding, by age subgroups (<60, 60–69, 70–79, 80 years). We quantified the reduction of death or myocardial infarction as the number needed to treat (NNT), and the increase of major bleeding as the number needed to harm (NNH).

Results: Subgroups had 11 155 (35%), 9727 (31%), 8468 (27%) and 2049 (7%) patients, respectively. The relative benefit of platelet glycoprotein IIb/IIIa receptor blockers did not differ significantly (p = 0.5) between age subgroups (OR (95% CI) for death or myocardial infarction: 0.86 (0.74 to 0.99), 0.90 (0.80 to 1.02), 0.97 (0.86 to 1.10), 0.90 (0.73 to 1.16); overall 0.91 (0.86 to 0.99). ORs for major bleeding were 1.9 (1.3 to 2.8), 1.9 (1.4 to 2.7), 1.6 (1.2 to 2.1) and 2.5 (1.5–4.1). Overall NNT was 105, and overall NNH was 90. The oldest patients had larger absolute increases in major bleeding, but also had the largest absolute reductions of death or myocardial infarction. Patients 80 years had half of the NNT and a third of the NNH of patients <60 years.

Conclusions: In patients with NSTE-ACS, the relative reduction of death or non-fatal myocardial infarction with platelet glycoprotein IIb/IIIa receptor blockers was independent of patient age. Larger absolute outcome reductions were seen in older patients, but with a higher risk of major bleeding. Close monitoring of these patients is warranted.

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• Kalyanasundaram, A., Berger, P., Kastrati, A. (2007). Effects of glycoprotein IIb/IIIa blockers. Heart 93: 1293-1293 [Full Text]  

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