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Early Glycoprotein IIb/IIIa Inhibitor Use for Non–ST‐segment Elevation Acute Coronary Syndrome: Patient Selection and Associated Treatment Patterns
Author(s) -
Hoekstra James W.,
Roe Matthew T.,
Peterson Eric D.,
Me Venu,
Mulgund Jyotsna,
Pollack Charles V.,
Miller Chadwick,
Palabrica Theresa,
Harrington Robert A.,
Ohman E. Magnus,
Gibler W. Brian
Publication year - 2005
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2004.11.029
Subject(s) - medicine , acute coronary syndrome , chest pain , emergency department , st elevation , cardiology , heart failure , coronary care unit , st segment , adverse effect , myocardial infarction , psychiatry
Objectives: The authors analyzed contemporary use of glycoprotein (GP) IIb/IIIa inhibitors in patients with non–ST‐segment elevation acute coronary syndrome (NSTE ACS) to determine patient selection patterns with early (<24 hours) GP IIb/IIIa inhibitor use and the relationship between GP IIb/IIIa inhibitor therapy and use of other guidelines‐recommended therapies for NSTE ACS. Methods: Using the CRUSADE Quality Improvement Initiative database, patient characteristics, in‐hospital treatments, and outcomes for 65,424 patients with ischemic chest pain of <24 hours' duration and either positive cardiac markers or ischemic electrocardiographic changes were analyzed. Data were collected from 443 U.S. hospitals from January 2001 to June 2003. Results: Only 35% of eligible patients received GP IIb/IIIa inhibitors <24 hours after hospital admission. Approximately one third of patients received GP IIb/IIIa inhibitors in the emergency department, one third in the coronary care unit, and one third in the catheterization laboratory. Admission to a cardiologist's care was the most significant associated factor with early GP IIb/IIIa inhibitor use, along with elevated cardiac markers or ST‐segment deviation. Patients at high risk for adverse cardiac events due to advanced age, congestive heart failure, or female gender were less likely to receive early GP IIb/IIIa inhibitor therapy. Patients who received early GP IIb/IIIa inhibitor therapy were more likely to receive other guidelines‐recommended therapies. Conclusions: Despite the American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommendations, early GP IIb/IIIa inhibitor therapy remains underutilized in patients with NSTE ACS and administration of early GP IIb/IIIa inhibitors is directed toward lower‐risk patients. Early GP IIb/IIIa inhibitor therapy is associated with improved overall adherence to the ACC/AHA guidelines.