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Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease.

Publication ,  Journal Article
Kong, DF; Califf, RM; Miller, DP; Moliterno, DJ; White, HD; Harrington, RA; Tcheng, JE; Lincoff, AM; Hasselblad, V; Topol, EJ
Published in: Circulation
December 22, 1998

BACKGROUND: Several platelet glycoprotein (GP) IIb/IIIa receptor antagonists have been evaluated in clinical trials. We conducted a systematic overview (meta-analysis) to assess the effect of these compounds on death, myocardial infarction (MI), and revascularization. METHODS AND RESULTS: ORs were calculated for 16 randomized, controlled trials of GP IIb/IIIa inhibitors. An empirical Bayesian random-effects model combined the outcomes of 32 135 patients. There was a significant mortality reduction by GP IIb/IIIa inhibitors at 48 to 96 hours, with an OR of 0.70 (95% CI, 0. 51 to 0.96; P<0.03), equivalent to a reduction of 1 death per 1000 patients treated. Mortality benefits at 30 days (OR, 0.87; 95% CI, 0. 74 to 1.02; P=0.08) and 6 months (OR, 0.97; 95% CI, 0.86 to 1.10; P=0.67) were not statistically significant. For the combined end point of death or MI, there was a highly significant (P<0.001) benefit for GP IIb/IIIa inhibitors at each time point. The 30-day OR was 0.76 (95% CI, 0.66 to 0.87), or 20 fewer events per 1000 patients treated. For the composite end point of death, MI, or revascularization, there was also a highly significant (P<0.001) benefit for GP IIb/IIIa inhibitors. At 30 days, the OR was 0.77 (95% CI, 0.68 to 0.86), or 30 fewer events per 1000 patients treated. The risk differences for death, death or MI, and composite outcomes were similar at 6 months, indicating a sustained absolute improvement. Similar benefit was seen when trials were subgrouped by therapeutic indication (percutaneous intervention versus acute coronary syndromes). CONCLUSIONS: Application of this new therapeutic class to clinical practice promises substantial benefit for both indications.

Duke Scholars

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

December 22, 1998

Volume

98

Issue

25

Start / End Page

2829 / 2835

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Myocardial Revascularization
  • Myocardial Ischemia
  • Myocardial Infarction
  • Humans
  • Double-Blind Method
  • Cardiovascular System & Hematology
 

Citation

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Kong, D. F., Califf, R. M., Miller, D. P., Moliterno, D. J., White, H. D., Harrington, R. A., … Topol, E. J. (1998). Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation, 98(25), 2829–2835. https://doi.org/10.1161/01.cir.98.25.2829
Kong, D. F., R. M. Califf, D. P. Miller, D. J. Moliterno, H. D. White, R. A. Harrington, J. E. Tcheng, A. M. Lincoff, V. Hasselblad, and E. J. Topol. “Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease.Circulation 98, no. 25 (December 22, 1998): 2829–35. https://doi.org/10.1161/01.cir.98.25.2829.
Kong DF, Califf RM, Miller DP, Moliterno DJ, White HD, Harrington RA, et al. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation. 1998 Dec 22;98(25):2829–35.
Kong, D. F., et al. “Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease.Circulation, vol. 98, no. 25, Dec. 1998, pp. 2829–35. Pubmed, doi:10.1161/01.cir.98.25.2829.
Kong DF, Califf RM, Miller DP, Moliterno DJ, White HD, Harrington RA, Tcheng JE, Lincoff AM, Hasselblad V, Topol EJ. Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation. 1998 Dec 22;98(25):2829–2835.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

December 22, 1998

Volume

98

Issue

25

Start / End Page

2829 / 2835

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Myocardial Revascularization
  • Myocardial Ischemia
  • Myocardial Infarction
  • Humans
  • Double-Blind Method
  • Cardiovascular System & Hematology