Abstract | OBJECTIVES: BACKGROUND: 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 microg/kg bolus + continuous infusion of 2.0 microg/kg/min for < or =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% <48 h vs. 20.9%, p = 0.001), and had higher 30-day mortality from shock (77.2% vs. 52.7%, p = 0.001). Randomization to eptifibatide did not affect the occurrence of shock (p = 0.71, adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.72-1.25). However, shock patients treated with eptifibatide had significantly reduced adjusted odds of 30-day death (p = 0.03, adjusted OR = 0.51, 95% CI = 0.28-0.94). 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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Authors | D Hasdai, R A Harrington, J S Hochman, R M Califf, A Battler, J W Box, M L Simoons, J Deckers, E J Topol, D R Holmes Jr |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 36
Issue 3
Pg. 685-92
(Sep 2000)
ISSN: 0735-1097 [Print] United States |
PMID | 10987585
(Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Chemical References |
- Platelet Glycoprotein GPIIb-IIIa Complex
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Topics |
- Aged
- Blood Platelets
(metabolism)
- Coronary Angiography
- Coronary Disease
(complications, diagnostic imaging, physiopathology, therapy)
- Double-Blind Method
- Electrocardiography
- Female
- Heart-Assist Devices
- Humans
- Male
- Middle Aged
- Myocardial Revascularization
- Platelet Glycoprotein GPIIb-IIIa Complex
(antagonists & inhibitors, metabolism)
- Prognosis
- Randomized Controlled Trials as Topic
- Retrospective Studies
- Shock
(etiology)
- Syndrome
- Time Factors
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