Coronary artery diseaseEffectiveness and Safety of Glycoprotein IIb/IIIa Inhibitors and Clopidogrel Alone and in Combination in Non–ST-Segment Elevation Myocardial Infarction (from the National Registry of Myocardial Infarction-4)
Section snippets
Data collection
The National Registry of Myocardial Infarction (NRMI) is a voluntary registry of cross-sectional data on patients hospitalized with confirmed myocardial infarction. Trained abstractors collected detailed data from the records of 632,146 patients admitted between July 2000 and December 2003 at 1,290 participating hospitals. The characteristics of the registry, data-gathering procedures, and reliability have been reported elsewhere.1, 2, 3 For patients included in the NRMI, the diagnosis of
Study population
Table 1 presents patients’ clinical and demographic characteristics. There was a larger proportion of women and older patients in the clopidogrel-only group. That group also had a larger proportion of patients with preexisting chronic renal insufficiency, myocardial infarction, hypertension, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, peripheral vascular disease, and previous coronary bypass graft surgery. There was a larger
Discussion
The main finding in this observational analysis is that, in patients with NSTEMI who did not undergo PCI, clopidogrel-only therapy is associated with a significant decrease in the composite of in-hospital mortality, reinfarction, and major bleeding compared with combination and GP IIb/IIIa inhibitor-only therapies. A second important finding in this study is that, in patients with NSTEMI who underwent PCI, a possible mortality benefit with combination therapy over patient therapy with a GP
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Cited by (14)
Variability in the Treatment of Non-ST-Segment Elevation Acute Coronary Syndrome and Its Consequences
2011, Revista Espanola de Cardiologia SuplementosSustained thromboprophylaxis mediated by an RBC-targeted pro-urokinase zymogen activated at the site of clot formation
2010, BloodCitation Excerpt :The pathogenesis of NSTEMI is thought to involve repetitive cycles of rethrombosis, involving incomplete clot lysis and redevelopment of occlusive coronary thrombi within a time interval ranging from few hours to few days in some patients. Percutaneous coronary intervention and stenting combined with antiplatelet therapy and heparin have improved survival marginally in selected subpopulations, but these approaches still do not provide protection to a substantial number of patients.20 Existing fibrinolytics are unsuitable for prophylactic use (half-life in blood < 20 minutes) and may cause intracranial bleeding, bleeding at sites of surgery and collateral damage in the CNS.
Optimizing primary PCI beyond "door to intervention time"-are we there yet?
2010, Cardiovascular Revascularization MedicineCitation Excerpt :Myocardial infarction at 30 days was significantly reduced by 2.3% (4.6% vs. 6.9%; RR, 0.63; CI, 0.56–0.70) at the cost of excessive major bleeding [increased by 1.4% (4.6 vs. 3.2; RR, 1.26; CI, 1.09–1.46)] and with no accounting for the excessive thrombocytopenia, minor bleeding, vascular complications, transfusions or allergic reactions. Multivariate and propensity analyses [6] compared the combined end point of in-hospital death, reinfarction, and major bleeding in 38,691 patients in the National Registry of Myocardial Infarction-4 (2000–2003); 65% received GPI only, 16.1% clopidogrel only, and 18.8% received both. The event rate was higher among patients who received both drugs than clopidogrel alone (odds ratio, 1.31; 95% CI, 0.99–1.72).
Underutilization of clopidogrel and glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute coronary syndrome patients: The Canadian Global Registry of Acute Coronary Events (GRACE) experience
2009, American Heart JournalCitation Excerpt :Although our observational study cannot establish any cause-and-effect relationship because of unmeasured confounders, the relatively low rate of major bleeding observed suggests that these antiplatelet therapies can be safely administered in the “real world” at the discretion of the treating physicians—it is also plausible that potent antiplatelet therapies were withheld from patients at high risk of bleeding. Although there have been a few studies looking at the early antiplatelet treatment patterns in NSTE-ACS population,5-8,32 our findings complement the results of these studies by evaluating the patterns of clopidogrel and GpIIb/IIIa inhibitor use, not only individually but also in relation to each other, in a real-world population. These data can also serve as a useful benchmark for future comparison, particularly in view of the recently published EARLY-ACS and ACUITY Timing trials.33,34
Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms
2007, Cardiovascular Revascularization MedicineCitation Excerpt :GPI use was associated with a significant 1.1% increase in major bleeding (1.4% vs. 2.5%; OR=1.64; 95% CI=1.36–1.97). Multivariate and propensity analyses [11] compared the combined end point of in-hospital death, reinfarction, and major bleeding in 38,691 patients in the National Registry of Myocardial Infarction-4 (2000–2003). Sixty-five percent received GPI only, 16.1% received clopidogrel only, and 18.8% received both.
The National Registry of Myocardial Infarction is funded by Genentech, Inc., South San Francisco, California. This analysis was supported by an unrestricted grant from Genentech, Inc.