Early Glycoprotein IIb/IIIa Inhibitor Use for Non-ST-segment Elevation Acute Coronary Syndrome: Patient Selection and Associated Treatment Patterns

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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. Meth- ods: 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 Ameri- can 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. Key words: glycoprotein IIb/IIIa inhibitors; non-ST-segment elevation acute coronary syndrome; guidelines-recommended thera- pies. ACADEMIC EMERGENCY MEDICINE 2005; 12: 431-438.

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