TY - JOUR
T1 - Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome
T2 - Patient selection and associated treatment patterns
AU - Hoekstra, James W.
AU - Roe, Matthew T.
AU - Peterson, Eric D.
AU - Menon, Venu
AU - Mulgund, Jyotsna
AU - Pollack, Charles V.
AU - Miller, Chadwick
AU - Palabrica, Theresa
AU - Harrington, Robert A.
AU - Ohman, E. Magnus
AU - Gibler, W. Brian
N1 - Funding Information:
CRUSADE is supported by Millennium Pharmaceuticals, Inc. (Cambridge, MA) and Schering Plough, Inc. (Kenilworth, NJ).
PY - 2005/5
Y1 - 2005/5
N2 - 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.
AB - 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.
KW - Glycoprotein IIb/IIIa inhibitors
KW - Guidelines-recommended therapies
KW - Non-ST-segment elevation acute coronary syndrome
UR - http://www.scopus.com/inward/record.url?scp=20944442420&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=20944442420&partnerID=8YFLogxK
U2 - 10.1197/j.aem.2004.11.029
DO - 10.1197/j.aem.2004.11.029
M3 - Article
C2 - 15863399
AN - SCOPUS:20944442420
SN - 1069-6563
VL - 12
SP - 431
EP - 438
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 5
ER -