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Effects of platelet glycoprotein IIb/IIIa receptor blockers in non-ST segment elevation acute coronary syndromes: benefit and harm in different age subgroups
  1. Adrián V Hernández1,
  2. Cynthia M Westerhout3,
  3. Ewout W Steyerberg1,
  4. John P A Ioannidis4,
  5. Héctor Bueno5,
  6. Harvey White6,
  7. Pierre Theroux7,
  8. David J Moliterno8,
  9. Paul W Armstrong3,
  10. Robert M Califf9,
  11. Lars C Wallentin10,
  12. Maarten L Simoons2,
  13. Eric Boersma2
  1. 1Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
  2. 2Clinical Epidemiology Unit, Department of Cardiology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
  3. 3Department of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  4. 4Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece
  5. 5Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain
  6. 6Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
  7. 7Department of Cardiology, Montreal Heart Institute, Montreal, Ontario, Canada
  8. 8Department of Cardiology, University of Kentucky, Lexington, Kentucky, USA
  9. 9Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USA
  10. 10Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden
  1. 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

Abstract

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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Footnotes

  • Published Online First 25 October 2006

  • Funding: Dr. AVH received support from The Netherlands Organisation for Scientific Research (ZON/MW 908-02-117).

  • Competing interests: DJM is a consultant for Merck, Centocor, and Eli Lilly, and has received honoraria from the Merck, Centocor, as well as from Roche. HW is a consultant for and has received honoraria from Merck. PT was principal investigator and chairman of the Steering Committee for the PRISM–PLUS trial. PWA has received research grants and honoraria from Eli Lilly and Schering–Plough. RMC has worked with Centocor, Lilly, COR, Schering-Plough, and Merck. MLS is a consultant for Merck, Centocor and Lilly, and has provided paid expert testimony to Schering–Plough.

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