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Outcomes with the use of glycoprotein IIb/IIIa inhibitors in non-ST-segment elevation acute coronary syndromes
  1. Omar H Dabbous (omar.dabbous{at}gmail.com)
  1. University of Massachusetts Medical School, United States
    1. Frederick A Anderson (fred.anderson{at}umassmed.edu)
    1. University of Massachusetts Medical School, United States
      1. Joel M Gore
      1. University of Massachusetts Medical School, United States
        1. Kim A Eagle (keagle{at}med.umich.edu)
        1. University of Michigan Health System, United States
          1. Keith AA Fox (k.a.a.fox{at}ed.ac.uk)
          1. University of Edinburgh, United Kingdom
            1. Rajendra H Mehta
            1. Duke Clinical Research Institute, United States
              1. Robert J Goldberg
              1. University of Massachusetts Medical School, United States
                1. Giancarlo Agnelli
                1. University of Perugia, United States
                  1. Ph Gabriel Steg
                  1. Bichat Hospital, France

                    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.

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

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

                    Patients 29,039 patients with NSTE ACS.

                    Main outcome measures Characteristics and outcomes were compared for trial-eligible (75.0%) and 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] 1.01-2.39), but not higher bleeding rates, than the eligible group. Use of GP IIb/IIIa inhibitors was associated with a trend towards lower six-month mortality in eligible (OR 0.86, 95% CI 0.72-1.02) and ineligible (OR 0.82, 95% CI 0.65-1.05) 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 were no less than in eligible patients.

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