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Robert M. Califf - One of the best experts on this subject based on the ideXlab platform.
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differential treatment benefit of Platelet Glycoprotein iib iiia inhibition with percutaneous coronary intervention versus medical therapy for acute coronary syndromes exploration of methods
Circulation, 2004Co-Authors: Karen S Pieper, Neal S. Kleiman, Vic Hasselblad, Eric Boersma, Paul W Armstrong, Anastasios A Tsiatis, Marie Davidian, Wei Ching Chang, Jeffrey Griffin, Robert M. CaliffAbstract:Background-Although many believe that Platelet Glycoprotein IIb/IIIa inhibitors should be used only in acute coronary syndrome patients undergoing percutaneous coronary intervention, supporting data from randomized clinical trials are tenuous. The assumption that these agents are useful only in conjunction with percutaneous coronary intervention is based primarily on inappropriate subgroup analyses performed across the Glycoprotein IIb/IIIa inhibitor trials. Methods and Results-We describe the problems with these analytical techniques and demonstrate that different approaches to the question can result in opposing answers. Conclusions-Clinical-practice decisions and practice guidelines should be based on overall trial results and not analyses of post-randomization subgroups.
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meta analysis of survival with Platelet Glycoprotein iib iiia antagonists for percutaneous coronary interventions
American Journal of Cardiology, 2003Co-Authors: David F Kong, Robert A. Harrington, James E Tcheng, Eric J Topol, Vic Hasselblad, Harvey D White, David E Kandzari, Robert M. CaliffAbstract:Abstract We performed a cumulative meta-analysis of available studies to evaluate the effect of intravenous Platelet Glycoprotein (GP) IIb/IIIa antagonists on survival at 30 days and 6 months after percutaneous coronary intervention (PCI). Compounds that block the GP IIb/IIIa receptor substantially reduce myocardial infarctions (MIs) and repeat revascularization. We included 12 trials, which enrolled 20,186 patients in all, in the analysis. Overall, 30-day mortality was significantly reduced with GP IIb/IIIa inhibition (odds ratio 0.73, 95% confidence interval 0.55 to 0.96, p = 0.024). Although 10 of the 12 trials showed a beneficial effect of GP IIb/IIIa inhibitor treatment on mortality, no individual trial detected a statistically significant mortality benefit. The 30-day mortality benefit became significant at the p
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Platelet Glycoprotein iib iiia inhibitors reduce mortality in diabetic patients with non st segment elevation acute coronary syndromes
Circulation, 2002Co-Authors: Marco Roffi, Robert M. Califf, David J. Moliterno, Derek P Chew, Debabrata Mukherjee, Deepak L Bhatt, Jennifer White, Christopher Heeschen, Christian W Hamm, Harvey D WhiteAbstract:Background Diabetes mellitus is a major risk factor for adverse outcomes after acute coronary syndromes (ACS). Because this disease may be associated with increased Platelet aggregation, we investigated whether diabetic patients with ACS derive particular benefit from Platelet Glycoprotein (GP) IIb/IIIa receptor inhibition. Methods and Results We performed a meta-analysis of the diabetic populations enrolled in the 6 large-scale Platelet GP IIb/IIIa inhibitor ACS trials: PRISM, PRISM-PLUS, PARAGON A, PARAGON B, PURSUIT, and GUSTO IV. Among 6458 diabetic patients, Platelet GP IIb/IIIa inhibition was associated with a significant mortality reduction at 30 days, from 6.2% to 4.6% (OR 0.74; 95% CI 0.59 to 0.92; P=0.007). Conversely, 23 072 nondiabetic patients had no survival benefit (3.0% versus 3.0%). The interaction between Platelet GP IIb/IIIa inhibition and diabetic status was statistically significant (P=0.036). Among 1279 diabetic patients undergoing percutaneous coronary intervention (PCI) during inde...
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reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and Platelet Glycoprotein iib iiia inhibition the gusto v randomised trial
The Lancet, 2001Co-Authors: A. Michael Lincoff, W B Gibler, E M Ohman, James T Willerson, Eric R Bates, Robert M. Califf, Judith S Hochman, Neal S. Kleiman, Liliana GrinfeldAbstract:Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and Platelet Glycoprotein IIb/IIIa inhibition : the GUSTO V randomised trial.
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management of patients with acute coronary syndromes in the united states by Platelet Glycoprotein iib iiia inhibition insights from the Platelet Glycoprotein iib iiia in unstable angina receptor suppression using integrilin therapy pursuit trial
Circulation, 2000Co-Authors: Michael A Lincoff, Robert A. Harrington, Robert M. Califf, Judith S Hochman, Neal S. Kleiman, Alan D Guerci, Magnus E Ohman, Carl J Pepine, Steven L Kopecky, Cynthia M PacchianaAbstract:Background—A multinational, randomized, placebo-controlled trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, PURSUIT) demonstrated that the Platelet Glycoprotein IIb/IIIa receptor antagonist eptifibatide reduced the incidence of death or myocardial infarction among patients with acute ischemic syndromes without ST-segment elevation. Because of expected differences in practice patterns, a prospectively planned analysis of outcomes as a function of regions of the world was performed. The current study provides a detailed assessment of eptifibatide among the subgroup of patients enrolled within the United States. Methods and Results—Patients presenting with chest pain within the previous 24 hours and ischemic ECG changes or creatine kinase–MB elevation were eligible for enrollment. Of the 10 948 patients randomized worldwide, 4035 were enrolled within the United States. Patients were allocated to placebo or eptifibatide infusion for up to 72 to 96 hours....
Eric J Topol - One of the best experts on this subject based on the ideXlab platform.
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meta analysis of survival with Platelet Glycoprotein iib iiia antagonists for percutaneous coronary interventions
American Journal of Cardiology, 2003Co-Authors: David F Kong, Robert A. Harrington, James E Tcheng, Eric J Topol, Vic Hasselblad, Harvey D White, David E Kandzari, Robert M. CaliffAbstract:Abstract We performed a cumulative meta-analysis of available studies to evaluate the effect of intravenous Platelet Glycoprotein (GP) IIb/IIIa antagonists on survival at 30 days and 6 months after percutaneous coronary intervention (PCI). Compounds that block the GP IIb/IIIa receptor substantially reduce myocardial infarctions (MIs) and repeat revascularization. We included 12 trials, which enrolled 20,186 patients in all, in the analysis. Overall, 30-day mortality was significantly reduced with GP IIb/IIIa inhibition (odds ratio 0.73, 95% confidence interval 0.55 to 0.96, p = 0.024). Although 10 of the 12 trials showed a beneficial effect of GP IIb/IIIa inhibitor treatment on mortality, no individual trial detected a statistically significant mortality benefit. The 30-day mortality benefit became significant at the p
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lack of benefit from intravenous Platelet Glycoprotein iib iiia receptor inhibition as adjunctive treatment for percutaneous interventions of aortocoronary bypass grafts a pooled analysis of five randomized clinical trials
Circulation, 2002Co-Authors: Marco Roffi, Stephen G. Ellis, Derek P Chew, Debabrata Mukherjee, Deepak L Bhatt, Mark Robbins, Leslie Cho, Khaled M Ziada, Danielle M Brennan, Eric J TopolAbstract:Background— Despite widespread use of Platelet Glycoprotein (GP) IIb/IIIa receptor inhibitors for percutaneous coronary interventions (PCI) of bypass grafts, data supporting this strategy are lacking. Methods and Results— A pooled analysis of 5 randomized intravenous GP IIb/IIIa inhibitor trials (EPIC, EPILOG, EPISTENT, IMPACT II, and PURSUIT) was performed, and outcomes of graft interventions were assessed at 30 days and 6 months. Compared with PCI of native circulation (n=13 158), graft interventions (n=627) were associated with worse outcomes and in particular with a doubling of mortality at 30 days (2.1% versus 1.0%, P=0.006) and 6 months (4.7% versus 2.0%, P<0.001). Revascularization of a graft was identified as an independent predictor of death, myocardial infarction, or revascularization at 6 months (hazard ratio, 1.42; 95% CI, 1.24 to 1.63; P<0.001). Among patients undergoing graft PCI, the incidence of the triple end point at 30 days was 16.5% in the Platelet GP IIb/IIIa inhibitor group and 12.6%...
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comparison of two Platelet Glycoprotein iib iiia inhibitors tirofiban and abciximab for the prevention of ischemic events with percutaneous coronary revascularization
The New England Journal of Medicine, 2001Co-Authors: Eric J Topol, Franzjosef Neumann, Eric A Cohen, David J Cohen, David J. Moliterno, Howard C Herrmann, Eric R Powers, Cindy L Grines, Michel E Bertrand, Gregg W StoneAbstract:Background In the setting of percutaneous coronary revascularization, agents in the class known as Platelet Glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of death or nonfatal myocardial infarction at 30 days. We assessed whether there are differences in safety or efficacy between two such inhibitors, tirofiban and abciximab. Methods Using a double-blind, double-dummy design at 149 hospitals in 18 countries, we randomly assigned patients to receive either tirofiban or abciximab before undergoing percutaneous coronary revascularization with the intent to perform stenting. The primary end point was a composite of death, nonfatal myocardial infarction, or urgent target-vessel revascularization at 30 days. The trial was designed and statistically powered to demonstrate the noninferiority of tirofiban as compared with abciximab. Results The primary end point occurred more frequently among the 2398 patients in the tirofiban group than among the 2411 patients in the abciximab group (7....
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Platelet Glycoprotein iib iiia blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent st segment elevation
Journal of the American College of Cardiology, 2000Co-Authors: David Hasdai, Robert A. Harrington, Robert M. Califf, Judith S Hochman, Eric J Topol, Maarten L Simoons, Alexander Battler, James W Box, Jaap W Deckers, David R HolmesAbstract:Abstract OBJECTIVES The study examined whether antiPlatelet treatment with eptifibatide affected the frequency and outcome of shock among patients in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial who had acute coronary syndromes but not persistent ST-segment elevation. BACKGROUND Preliminary reports suggest a salutary effect of antiPlatelet agents when shock complicates acute myocardial infarction. METHODS We analyzed the impact of antiPlatelet treatment with eptifibatide on the frequency and outcome of cardiogenic shock developing after enrollment. PURSUIT was a double-blind, randomized trial that examined the efficacy of eptifibatide (180 μg/kg bolus + continuous infusion of 2.0 μg/kg/min for ≤96 h) versus placebo among patients who had acute coronary syndromes but not persistent ST-segment elevation. RESULTS Shock developed in 2.5% of the 9,449 patients at a median (25th, 75th interquartiles) of 94.0 (38, 206) h. Death by 30 days occurred in 65.8% of shock patients. Patients who had acute myocardial infarction upon enrollment had a greater incidence of shock (2.9% vs. 2.1%, p = 0.01), developed shock earlier (40.2% CONCLUSIONS Patients with shock treated with eptifibatide had significantly reduced adjusted odds of death, suggesting a salutary effect of antiPlatelet therapy on shock. This finding warrants verification in specifically designed studies.
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Platelet Glycoprotein iib iiia receptor blockade in coronary artery disease
Journal of the American College of Cardiology, 2000Co-Authors: Michael A Lincoff, Robert M. Califf, Eric J TopolAbstract:New strategies for profound inhibition of Platelet activity at the injured coronary plaque focus on blockade of the Platelet surface membrane Glycoprotein IIb/IIIa receptor, which binds circulating fibrinogen or von Willebrand factor and crosslinks Platelets as the final common pathway to Platelet aggregation. Intravenous agents directed against this receptor include the chimeric monoclonal antibody fragment abciximab, the peptide inhibitor eptifibatide and nonpeptide mimetics tirofiban and lamifiban. Over 33,000 patients have been evaluated in 11 large-scale, placebo-controlled trials of these agents. During percutaneous coronary intervention, an absolute reduction of 1.5% to 6.5% in the 30-day risk of death, myocardial infarction or repeat urgent revascularization has been observed, with some variability in treatment effect among the agents tested (abciximab, eptifibatide and tirofiban). Treatment effect is achieved early with every modality of revascularization and is maintained over the long-term (up to three years). Increased bleeding risk may be minimized by reduction and weight-adjustment of concomitant heparin dosing. In the acute coronary syndromes without ST segment elevation, absolute 1.5% to 3.2% reductions in 30-day rates of death or myocardial (re-) infarction have been achieved with two to four day courses of eptifibatide or tirofiban. Clinical benefit accrues during the period of drug infusion and is durable. Treatment effect may be enhanced among patients undergoing early coronary revascularization, with evidence of stabilization before intervention and suppression of postprocedural ischemic events. Thus, blockade of the Platelet Glycoprotein IIb/IIIa receptor reduces ischemic complications when used as an adjunct to percutaneous coronary intervention or the management of acute ischemic syndromes.
Neal S. Kleiman - One of the best experts on this subject based on the ideXlab platform.
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differential treatment benefit of Platelet Glycoprotein iib iiia inhibition with percutaneous coronary intervention versus medical therapy for acute coronary syndromes exploration of methods
Circulation, 2004Co-Authors: Karen S Pieper, Neal S. Kleiman, Vic Hasselblad, Eric Boersma, Paul W Armstrong, Anastasios A Tsiatis, Marie Davidian, Wei Ching Chang, Jeffrey Griffin, Robert M. CaliffAbstract:Background-Although many believe that Platelet Glycoprotein IIb/IIIa inhibitors should be used only in acute coronary syndrome patients undergoing percutaneous coronary intervention, supporting data from randomized clinical trials are tenuous. The assumption that these agents are useful only in conjunction with percutaneous coronary intervention is based primarily on inappropriate subgroup analyses performed across the Glycoprotein IIb/IIIa inhibitor trials. Methods and Results-We describe the problems with these analytical techniques and demonstrate that different approaches to the question can result in opposing answers. Conclusions-Clinical-practice decisions and practice guidelines should be based on overall trial results and not analyses of post-randomization subgroups.
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Platelet Glycoprotein iib iiia inhibition in acute coronary syndromes gradient of benefit related to the revascularization strategy
European Heart Journal, 2002Co-Authors: Marco Roffi, David J. Moliterno, Derek P Chew, Debabrata Mukherjee, Deepak L Bhatt, Jennifer White, Christopher Heeschen, Christian W Hamm, Mark Robbins, Neal S. KleimanAbstract:Aims To assess the efficacy of Platelet Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed. Methods and Results We performed a meta-analysis of the randomized clinical trials of Platelet Glycoprotein IIb/IIIa inhibitor therapy in the medical management of non-ST-elevation acute coronary syndromes. Among 29570 patients, IIb/IIIa integrin blockade was associated with a reduction in death or non-fatal myocardial infarction at 30 days, from 11·5% to 10·7% (odds ratio 0·91, P =0·02). Patients undergoing percutaneous coronary intervention during index hospitalization sustained a greater reduction in ischaemic events (odds ratio 0·82, P =0·01) than patients medically managed (odds ratio 0·95, P =0·27). Among patients undergoing intervention, the benefit was more pronounced if the procedure was performed during Glycoprotein IIb/IIIa inhibitor infusion (odds ratio 0·74; P =0·02), than if revascularization was performed after drug discontinuation (odds ratio 0·87, P =0·17). Conclusion This analysis, including the entire large-scale trial experience of intravenous Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed, demonstrates an overall significant, albeit moderate, reduction in 30-day death or myocardial infarction associated with therapy. Although not based on a prospectively defined hypothesis, the findings suggest a gradient of benefit conferred by these agents depending on the revascularization strategy used. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .
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long term efficacy of Platelet Glycoprotein iib iiia integrin blockade with eptifibatide in coronary stent intervention
JAMA, 2002Co-Authors: Conor J Oshea, Neal S. Kleiman, Marino Labinaz, Ian C Gilchrist, Christopher E Buller, Warren J Cantor, Bleakley A Chandler, Eric A Cohen, David J Cohen, Mina MadanAbstract:ContextIn the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a Platelet Glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days.ObjectiveTo determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention.Design and SettingThe ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada.ParticipantsA total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation.InterventionPatients were randomly assigned to receive placebo (n = 1024) or eptifibatide (two 180-µg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 µg/kg per minute; n = 1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine.Main Outcome MeasuresComposite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment.ResultsComplete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P = .001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P = .007).ConclusionsLong-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the Platelet Glycoprotein IIb/IIIa integrin with eptifibatide.
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reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and Platelet Glycoprotein iib iiia inhibition the gusto v randomised trial
The Lancet, 2001Co-Authors: A. Michael Lincoff, W B Gibler, E M Ohman, James T Willerson, Eric R Bates, Robert M. Califf, Judith S Hochman, Neal S. Kleiman, Liliana GrinfeldAbstract:Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and Platelet Glycoprotein IIb/IIIa inhibition : the GUSTO V randomised trial.
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management of patients with acute coronary syndromes in the united states by Platelet Glycoprotein iib iiia inhibition insights from the Platelet Glycoprotein iib iiia in unstable angina receptor suppression using integrilin therapy pursuit trial
Circulation, 2000Co-Authors: Michael A Lincoff, Robert A. Harrington, Robert M. Califf, Judith S Hochman, Neal S. Kleiman, Alan D Guerci, Magnus E Ohman, Carl J Pepine, Steven L Kopecky, Cynthia M PacchianaAbstract:Background—A multinational, randomized, placebo-controlled trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, PURSUIT) demonstrated that the Platelet Glycoprotein IIb/IIIa receptor antagonist eptifibatide reduced the incidence of death or myocardial infarction among patients with acute ischemic syndromes without ST-segment elevation. Because of expected differences in practice patterns, a prospectively planned analysis of outcomes as a function of regions of the world was performed. The current study provides a detailed assessment of eptifibatide among the subgroup of patients enrolled within the United States. Methods and Results—Patients presenting with chest pain within the previous 24 hours and ischemic ECG changes or creatine kinase–MB elevation were eligible for enrollment. Of the 10 948 patients randomized worldwide, 4035 were enrolled within the United States. Patients were allocated to placebo or eptifibatide infusion for up to 72 to 96 hours....
David J. Moliterno - One of the best experts on this subject based on the ideXlab platform.
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Platelet Glycoprotein iib iiia inhibition in acute coronary syndromes gradient of benefit related to the revascularization strategy
European Heart Journal, 2002Co-Authors: Marco Roffi, David J. Moliterno, Derek P Chew, Debabrata Mukherjee, Deepak L Bhatt, Jennifer White, Christopher Heeschen, Christian W Hamm, Mark Robbins, Neal S. KleimanAbstract:Aims To assess the efficacy of Platelet Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed. Methods and Results We performed a meta-analysis of the randomized clinical trials of Platelet Glycoprotein IIb/IIIa inhibitor therapy in the medical management of non-ST-elevation acute coronary syndromes. Among 29570 patients, IIb/IIIa integrin blockade was associated with a reduction in death or non-fatal myocardial infarction at 30 days, from 11·5% to 10·7% (odds ratio 0·91, P =0·02). Patients undergoing percutaneous coronary intervention during index hospitalization sustained a greater reduction in ischaemic events (odds ratio 0·82, P =0·01) than patients medically managed (odds ratio 0·95, P =0·27). Among patients undergoing intervention, the benefit was more pronounced if the procedure was performed during Glycoprotein IIb/IIIa inhibitor infusion (odds ratio 0·74; P =0·02), than if revascularization was performed after drug discontinuation (odds ratio 0·87, P =0·17). Conclusion This analysis, including the entire large-scale trial experience of intravenous Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes primarily medically managed, demonstrates an overall significant, albeit moderate, reduction in 30-day death or myocardial infarction associated with therapy. Although not based on a prospectively defined hypothesis, the findings suggest a gradient of benefit conferred by these agents depending on the revascularization strategy used. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .
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impact of different Platelet Glycoprotein iib iiia receptor inhibitors among diabetic patients undergoing percutaneous coronary intervention do tirofiban and reopro give similar efficacy outcomes trial target 1 year follow up
Circulation, 2002Co-Authors: Marco Roffi, David J. Moliterno, Howard C Herrmann, Eric R Powers, Cindy L Grines, Michel E Bertrand, Peter M Dibattiste, Bernhard Meier, Katherine E Harris, Laura A DemopoulosAbstract:Background— The Platelet Glycoprotein IIb/IIIa receptor inhibitor abciximab, a monoclonal antibody, has been shown to improve early and late outcomes among diabetic patients undergoing percutaneous coronary intervention (PCI). It is unknown whether small-molecule agents confer similar benefits. Methods and Results— In 18 countries, 4809 patients undergoing PCI with stent implantation were randomized to tirofiban or abciximab. At the time of enrollment, patients were stratified according to diabetes status. As compared with non-diabetic patients, patients with diabetes (n=1117) showed similar 30-day ischemic outcomes, an increased incidence of any target vessel revascularization (TVR) at 6 months (10.3% versus 7.8%; P= 0.008), and a trend toward higher 1-year mortality (2.5% versus 1.6%; P=0.056). Among diabetic patients randomized to tirofiban (n=560), the incidence of death, myocardial infarction (MI), or urgent TVR at 30 days was 6.2%, and among those randomized to abciximab (n=557) it was 5.4% (hazard ...
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Platelet Glycoprotein iib iiia inhibitors reduce mortality in diabetic patients with non st segment elevation acute coronary syndromes
Circulation, 2002Co-Authors: Marco Roffi, Robert M. Califf, David J. Moliterno, Derek P Chew, Debabrata Mukherjee, Deepak L Bhatt, Jennifer White, Christopher Heeschen, Christian W Hamm, Harvey D WhiteAbstract:Background Diabetes mellitus is a major risk factor for adverse outcomes after acute coronary syndromes (ACS). Because this disease may be associated with increased Platelet aggregation, we investigated whether diabetic patients with ACS derive particular benefit from Platelet Glycoprotein (GP) IIb/IIIa receptor inhibition. Methods and Results We performed a meta-analysis of the diabetic populations enrolled in the 6 large-scale Platelet GP IIb/IIIa inhibitor ACS trials: PRISM, PRISM-PLUS, PARAGON A, PARAGON B, PURSUIT, and GUSTO IV. Among 6458 diabetic patients, Platelet GP IIb/IIIa inhibition was associated with a significant mortality reduction at 30 days, from 6.2% to 4.6% (OR 0.74; 95% CI 0.59 to 0.92; P=0.007). Conversely, 23 072 nondiabetic patients had no survival benefit (3.0% versus 3.0%). The interaction between Platelet GP IIb/IIIa inhibition and diabetic status was statistically significant (P=0.036). Among 1279 diabetic patients undergoing percutaneous coronary intervention (PCI) during inde...
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Platelet Glycoprotein iib iiia inhibitors in acute coronary syndromes a meta analysis of all major randomised clinical trials
The Lancet, 2002Co-Authors: Eric Boersma, Robert A. Harrington, David J. Moliterno, Harvey D White, Pierre Theroux, Frans Van De Werf, Anneke De Torbal, Paul W Armstrong, Lars Wallentin, Robert G WilcoxAbstract:Summary Background Platelet Glycoprotein IIb/IIIa inhibitors have been shown to reduce cardiac complications in patients undergoing percutaneous coronary intervention. The clinical efficacy of these drugs in acute coronary syndromes, however, is still unclear. We did a meta-analysis of all large randomised trials designed to study the clinical efficacy and safety of Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes who were not routinely scheduled to undergo early coronary revascularisation. Methods Inclusion criteria were: randomisation of patients with acute coronary syndromes but without persistent ST elevation; comparison of a Glycoprotein IIb/IIIa inhibitor with placebo or control therapy; non-recommendation of early coronary revascularisation during study-drug infusion; and enrolment of at least 1000 patients. Data on individual patients were obtained from all participants in these trials.
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comparison of two Platelet Glycoprotein iib iiia inhibitors tirofiban and abciximab for the prevention of ischemic events with percutaneous coronary revascularization
The New England Journal of Medicine, 2001Co-Authors: Eric J Topol, Franzjosef Neumann, Eric A Cohen, David J Cohen, David J. Moliterno, Howard C Herrmann, Eric R Powers, Cindy L Grines, Michel E Bertrand, Gregg W StoneAbstract:Background In the setting of percutaneous coronary revascularization, agents in the class known as Platelet Glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of death or nonfatal myocardial infarction at 30 days. We assessed whether there are differences in safety or efficacy between two such inhibitors, tirofiban and abciximab. Methods Using a double-blind, double-dummy design at 149 hospitals in 18 countries, we randomly assigned patients to receive either tirofiban or abciximab before undergoing percutaneous coronary revascularization with the intent to perform stenting. The primary end point was a composite of death, nonfatal myocardial infarction, or urgent target-vessel revascularization at 30 days. The trial was designed and statistically powered to demonstrate the noninferiority of tirofiban as compared with abciximab. Results The primary end point occurred more frequently among the 2398 patients in the tirofiban group than among the 2411 patients in the abciximab group (7....
Robert A. Harrington - One of the best experts on this subject based on the ideXlab platform.
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complementary effects of thienopyridine pretreatment and Platelet Glycoprotein iib iiia integrin blockade with eptifibatide in coronary stent intervention results from the esprit trial
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeanpierre Dery, Mina Madan, Thaddeus R Tolleson, J C Oshea, C. M. Gibson, J Mathias, Karen S Pieper, Robert A. Harrington, M. E. Campbell, James E TchengAbstract:Objectives: This analysis sought to investigate the complementary effect of thienopyridine pretreatment and Platelet Glycoprotein (GP) IIb/IIIa integrin blockade in coronary stent intervention. Background: Definitive evidence supporting combined antiPlatelet therapy consisting of thienopyridine pretreatment and GP IIb/IIIa receptor blockade in patients undergoing percutaneous coronary intervention (PCI) with stent implantation is limited. Methods: We retrospectively analyzed clinical outcomes by thienopyridine use in the 2,040 patients randomized to eptifibatide or placebo who underwent PCI in the ESPRIT trial. Results: A total of 901 patients received a loading dose of thienopyridine before PCI (group 1), 123 received thienopyridine pretreatment without a loading dose (group 2), and 1,016 were not treated with thienopyridine before PCI (group 3). The composite incidence of death or myocardial infarction at 30 days was significantly lower in group 1 than in groups 2 and 3 combined (OR, 0.71 [95%CI, 0.52–0.99]; P = 0.0417). A similar trend was seen for the composite of death, myocardial infarction, or urgent target vessel revascularization (unadjusted OR, 0.77 [0.57–1.05]; P = 0.1025). After adjusting for baseline characteristics, these differences were no longer significant. No interactions were identified with eptifibatide assignment for any of the group comparisons. Conclusions: Pretreatment with a loading dose of thienopyridine lowers the rate of ischemic complications regardless of treatment with a GP IIb/IIIa inhibitor. Conversely, the efficacy of eptifibatide is maintained whether or not a loading dose of a thienopyridine is administered. Optimal outcomes are achieved in patients receiving thienopyridine pretreatment along with Platelet GP IIb/IIIa inhibitor therapy. © 2007 Wiley-Liss, Inc.
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complementary effects of thienopyridine pretreatment and Platelet Glycoprotein iib iiia integrin blockade with eptifibatide in coronary stent intervention results from the esprit trial
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeanpierre Dery, Mina Madan, Thaddeus R Tolleson, J C Oshea, C. M. Gibson, J Mathias, Karen S Pieper, Robert A. Harrington, M. E. Campbell, James E TchengAbstract:Objectives: This analysis sought to investigate the complementary effect of thienopyridine pretreatment and Platelet Glycoprotein (GP) IIb/IIIa integrin blockade in coronary stent intervention. Background: Definitive evidence supporting combined antiPlatelet therapy consisting of thienopyridine pretreatment and GP IIb/IIIa receptor blockade in patients undergoing percutaneous coronary intervention (PCI) with stent implantation is limited. Methods: We retrospectively analyzed clinical outcomes by thienopyridine use in the 2,040 patients randomized to eptifibatide or placebo who underwent PCI in the ESPRIT trial. Results: A total of 901 patients received a loading dose of thienopyridine before PCI (group 1), 123 received thienopyridine pretreatment without a loading dose (group 2), and 1,016 were not treated with thienopyridine before PCI (group 3). The composite incidence of death or myocardial infarction at 30 days was significantly lower in group 1 than in groups 2 and 3 combined (OR, 0.71 [95%CI, 0.52–0.99]; P = 0.0417). A similar trend was seen for the composite of death, myocardial infarction, or urgent target vessel revascularization (unadjusted OR, 0.77 [0.57–1.05]; P = 0.1025). After adjusting for baseline characteristics, these differences were no longer significant. No interactions were identified with eptifibatide assignment for any of the group comparisons. Conclusions: Pretreatment with a loading dose of thienopyridine lowers the rate of ischemic complications regardless of treatment with a GP IIb/IIIa inhibitor. Conversely, the efficacy of eptifibatide is maintained whether or not a loading dose of a thienopyridine is administered. Optimal outcomes are achieved in patients receiving thienopyridine pretreatment along with Platelet GP IIb/IIIa inhibitor therapy. © 2007 Wiley-Liss, Inc.
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meta analysis of survival with Platelet Glycoprotein iib iiia antagonists for percutaneous coronary interventions
American Journal of Cardiology, 2003Co-Authors: David F Kong, Robert A. Harrington, James E Tcheng, Eric J Topol, Vic Hasselblad, Harvey D White, David E Kandzari, Robert M. CaliffAbstract:Abstract We performed a cumulative meta-analysis of available studies to evaluate the effect of intravenous Platelet Glycoprotein (GP) IIb/IIIa antagonists on survival at 30 days and 6 months after percutaneous coronary intervention (PCI). Compounds that block the GP IIb/IIIa receptor substantially reduce myocardial infarctions (MIs) and repeat revascularization. We included 12 trials, which enrolled 20,186 patients in all, in the analysis. Overall, 30-day mortality was significantly reduced with GP IIb/IIIa inhibition (odds ratio 0.73, 95% confidence interval 0.55 to 0.96, p = 0.024). Although 10 of the 12 trials showed a beneficial effect of GP IIb/IIIa inhibitor treatment on mortality, no individual trial detected a statistically significant mortality benefit. The 30-day mortality benefit became significant at the p
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Platelet Glycoprotein iib iiia inhibitors in acute coronary syndromes a meta analysis of all major randomised clinical trials
The Lancet, 2002Co-Authors: Eric Boersma, Robert A. Harrington, David J. Moliterno, Harvey D White, Pierre Theroux, Frans Van De Werf, Anneke De Torbal, Paul W Armstrong, Lars Wallentin, Robert G WilcoxAbstract:Summary Background Platelet Glycoprotein IIb/IIIa inhibitors have been shown to reduce cardiac complications in patients undergoing percutaneous coronary intervention. The clinical efficacy of these drugs in acute coronary syndromes, however, is still unclear. We did a meta-analysis of all large randomised trials designed to study the clinical efficacy and safety of Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes who were not routinely scheduled to undergo early coronary revascularisation. Methods Inclusion criteria were: randomisation of patients with acute coronary syndromes but without persistent ST elevation; comparison of a Glycoprotein IIb/IIIa inhibitor with placebo or control therapy; non-recommendation of early coronary revascularisation during study-drug infusion; and enrolment of at least 1000 patients. Data on individual patients were obtained from all participants in these trials.
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management of patients with acute coronary syndromes in the united states by Platelet Glycoprotein iib iiia inhibition insights from the Platelet Glycoprotein iib iiia in unstable angina receptor suppression using integrilin therapy pursuit trial
Circulation, 2000Co-Authors: Michael A Lincoff, Robert A. Harrington, Robert M. Califf, Judith S Hochman, Neal S. Kleiman, Alan D Guerci, Magnus E Ohman, Carl J Pepine, Steven L Kopecky, Cynthia M PacchianaAbstract:Background—A multinational, randomized, placebo-controlled trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, PURSUIT) demonstrated that the Platelet Glycoprotein IIb/IIIa receptor antagonist eptifibatide reduced the incidence of death or myocardial infarction among patients with acute ischemic syndromes without ST-segment elevation. Because of expected differences in practice patterns, a prospectively planned analysis of outcomes as a function of regions of the world was performed. The current study provides a detailed assessment of eptifibatide among the subgroup of patients enrolled within the United States. Methods and Results—Patients presenting with chest pain within the previous 24 hours and ischemic ECG changes or creatine kinase–MB elevation were eligible for enrollment. Of the 10 948 patients randomized worldwide, 4035 were enrolled within the United States. Patients were allocated to placebo or eptifibatide infusion for up to 72 to 96 hours....