A risk score system for predicting adverse outcomes and magnitude of benefit with glycoprotein IIb/IIIa inhibitor therapy in patients with unstable angina pectoris☆
Section snippets
Patients and end points
We analyzed the 1,915 patients enrolled in the PRISM-PLUS trial.3 In brief, patients with unstable angina or non-ST elevation myocardial infarction were randomly assigned to receive 1 of 3 regimens: tirofiban, tirofiban plus heparin, or heparin alone. Predefined primary end points were death, new myocardial infarction, and refractory ischemia. Myocardial infarction was defined as a new episode of chest pain with new electrocardiographic changes and an increase in serum creatine kinase to 2
Baseline characteristics
The baseline characteristics of the 1,915 patients analyzed in this study are listed in Table 1. Coronary angiography, which was encouraged per protocol, was performed during hospitalization in 90% of patients. Approximately 31% of patients underwent a percutaneous coronary intervention and 23% underwent coronary artery bypass graft surgery (CABG).
Risk factors for major adverse cardiac events
The odds ratio associated with each of the baseline characteristics for both the prespecified primary composite end point of death, myocardial
Discussion
The heterogeneity in outcome among patients presenting with unstable angina has challenged clinicians. The development of new and relatively expensive antiplatelet and antithrombin therapies has only underscored the need for an accurate and simple method for risk stratification in these patients to assist in triage to therapies. In our study, we identified 5 independent risk factors for the composite end point of death, myocardial infarction, or refractory ischemia at 7 days: age >65 years,
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Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms
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2005, American Heart JournalCitation Excerpt :Furthermore, troponin levels could not be used because they were not determined in all hospitals. These data and others were also missing from the 2 trials that served to establish and validate the TIMI score4 and also from the score as applied to the PRISM-PLUS data.5,7 Missing values in all these studies were shown to have little impact on the global score's performance.
Tirofiban therapy for patients with acute coronary syndromes and prior coronary artery bypass grafting in the PRISM-PLUS trial
2004, American Journal of CardiologyCitation Excerpt :There were no fatal or intracranial hemorrhages attributable to the addition of tirofiban to heparin. In the PRISM-PLUS trial, patients with prior CABG presented with more complex clinical characteristics, including those predictive of benefit from therapy with tirofiban, such as advanced age, prior β blocker or aspirin use, ST-segment depression, and high TIMI risk scores.6,7 Consistent with prior studies,1,8–11 patients with an ACS and prior CABG had a very high incidence of ischemic complications.
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This study was supported in part by a research grant from John and Marilee Polmonari. Drs. Sabatine and Januzzi are recipients of the William A. Schreyer Clinical Fellowship in Cardiology. Manuscript received January 11, 2001; revised manuscript received and accepted April 4, 2001.