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Effectiveness and safety of glycoprotein IIb/IIIa inhibitors and clopidogrel alone and in combination in non-ST-segment elevation myocardial infarction (from the National Registry of Myocardial Infarction-4).
Am J Cardiol. 2006 Nov 01; 98(9):1125-31.AJ

Abstract

We investigated whether a combination of clopidogrel and glycoprotein (GP) IIb/IIIa inhibitors safely decreases hospital mortality, reinfarction, and major bleeding beyond either therapy alone in patients with non-ST-elevation myocardial infarction (NSTEMI). GP IIb/IIIa inhibitors and clopidogrel, separately, have been shown to decrease adverse outcomes in patients with non-ST-elevation acute coronary syndromes, but the need for combination therapy is uncertain. Multivariate and propensity analyses compared the frequency of death, reinfarction, and major bleeding during hospitalization in 38,691 patients with NSTEMI who were enrolled in the National Registry of Myocardial Infarction 4 from July 2000 to December 2003. Of these, 65% received GP IIb/IIIa inhibitors only, 16.1% clopidogrel only, and 18.8% combination therapy. Among patients who did not undergo percutaneous coronary intervention (PCI), the composite end point of death, reinfarction, and major bleeding was significantly lower with combination therapy than with GP IIb/IIIa inhibitors alone (odds ratio 0.77, 95% confidence interval 0.67 to 0.88). In contrast, this composite end point was significantly higher when combination therapy was employed rather than clopidogrel alone (odds ratio 1.55, 95% confidence interval 1.33 to 1.81). However, among patients who underwent PCI, the composite end point was similar between combination therapy and GP IIb/IIIa inhibitor-only groups (odds ratio 1.01, 95% confidence interval 0.89 to 1.14). Further, there was a strong trend toward a higher composite end point among patients who received combination therapy rather than clopidogrel alone (odds ratio 1.31, 95% confidence interval 0.99 to 1.72). In conclusion, commonly employed strategies using a GP IIb/IIIa inhibitor alone or with the combination of clopidogrel plus GP IIb/IIIa inhibitor in NSTEMI may not be justified in comparison with a simpler strategy of clopidogrel used alone, especially in patients who have not undergone PCI.

Authors+Show Affiliations

Division of Cardiology, University of California, San Diego, San Diego, California, USA. guibmarin@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17056312

Citation

Bromberg-Marin, Guilherme, et al. "Effectiveness and Safety of Glycoprotein IIb/IIIa Inhibitors and Clopidogrel Alone and in Combination in non-ST-segment Elevation Myocardial Infarction (from the National Registry of Myocardial Infarction-4)." The American Journal of Cardiology, vol. 98, no. 9, 2006, pp. 1125-31.
Bromberg-Marin G, Marin-Neto JA, Parsons LS, et al. Effectiveness and safety of glycoprotein IIb/IIIa inhibitors and clopidogrel alone and in combination in non-ST-segment elevation myocardial infarction (from the National Registry of Myocardial Infarction-4). Am J Cardiol. 2006;98(9):1125-31.
Bromberg-Marin, G., Marin-Neto, J. A., Parsons, L. S., Canto, J. G., & Rogers, W. J. (2006). Effectiveness and safety of glycoprotein IIb/IIIa inhibitors and clopidogrel alone and in combination in non-ST-segment elevation myocardial infarction (from the National Registry of Myocardial Infarction-4). The American Journal of Cardiology, 98(9), 1125-31.
Bromberg-Marin G, et al. Effectiveness and Safety of Glycoprotein IIb/IIIa Inhibitors and Clopidogrel Alone and in Combination in non-ST-segment Elevation Myocardial Infarction (from the National Registry of Myocardial Infarction-4). Am J Cardiol. 2006 Nov 1;98(9):1125-31. PubMed PMID: 17056312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness and safety of glycoprotein IIb/IIIa inhibitors and clopidogrel alone and in combination in non-ST-segment elevation myocardial infarction (from the National Registry of Myocardial Infarction-4). AU - Bromberg-Marin,Guilherme, AU - Marin-Neto,Jose A, AU - Parsons,Lori S, AU - Canto,John G, AU - Rogers,William J, AU - ,, Y1 - 2006/08/31/ PY - 2006/02/08/received PY - 2006/05/17/revised PY - 2006/05/17/accepted PY - 2006/10/24/pubmed PY - 2006/12/9/medline PY - 2006/10/24/entrez SP - 1125 EP - 31 JF - The American journal of cardiology JO - Am J Cardiol VL - 98 IS - 9 N2 - We investigated whether a combination of clopidogrel and glycoprotein (GP) IIb/IIIa inhibitors safely decreases hospital mortality, reinfarction, and major bleeding beyond either therapy alone in patients with non-ST-elevation myocardial infarction (NSTEMI). GP IIb/IIIa inhibitors and clopidogrel, separately, have been shown to decrease adverse outcomes in patients with non-ST-elevation acute coronary syndromes, but the need for combination therapy is uncertain. Multivariate and propensity analyses compared the frequency of death, reinfarction, and major bleeding during hospitalization in 38,691 patients with NSTEMI who were enrolled in the National Registry of Myocardial Infarction 4 from July 2000 to December 2003. Of these, 65% received GP IIb/IIIa inhibitors only, 16.1% clopidogrel only, and 18.8% combination therapy. Among patients who did not undergo percutaneous coronary intervention (PCI), the composite end point of death, reinfarction, and major bleeding was significantly lower with combination therapy than with GP IIb/IIIa inhibitors alone (odds ratio 0.77, 95% confidence interval 0.67 to 0.88). In contrast, this composite end point was significantly higher when combination therapy was employed rather than clopidogrel alone (odds ratio 1.55, 95% confidence interval 1.33 to 1.81). However, among patients who underwent PCI, the composite end point was similar between combination therapy and GP IIb/IIIa inhibitor-only groups (odds ratio 1.01, 95% confidence interval 0.89 to 1.14). Further, there was a strong trend toward a higher composite end point among patients who received combination therapy rather than clopidogrel alone (odds ratio 1.31, 95% confidence interval 0.99 to 1.72). In conclusion, commonly employed strategies using a GP IIb/IIIa inhibitor alone or with the combination of clopidogrel plus GP IIb/IIIa inhibitor in NSTEMI may not be justified in comparison with a simpler strategy of clopidogrel used alone, especially in patients who have not undergone PCI. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/17056312/Effectiveness_and_safety_of_glycoprotein_IIb/IIIa_inhibitors_and_clopidogrel_alone_and_in_combination_in_non_ST_segment_elevation_myocardial_infarction__from_the_National_Registry_of_Myocardial_Infarction_4__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)01356-7 DB - PRIME DP - Unbound Medicine ER -