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- Title
Early Glycoprotein IIb/IIIa Inhibitor Use for Non-ST-segment Elevation Acute Coronary Syndrome: Patient Selection and Associated Treatment Patterns.
- Authors
Hoekstra, James W.; Roe, Matthew T.; Peterson, Eric D.; Menon, Venu; Mulgund, Jyotsna; Pollack, Charles V.; Miller, Chadwick; Palabrica, Theresa; Harrington, Robert A.; Ohman, E. Magnus; Gibler, W. Brian
- Abstract
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.
- Publication
Academic Emergency Medicine, 2005, Vol 12, Issue 5, p431
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1197/j.aem.2004.11.029