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GP IIb/IIIa receptor antagonists in unstable angina: troponin level-based patient selection

C.W. Hamm1

Kerckhoff Heart Center, Bad Nauheim, Germany

1 Correspondence: Christian W. Hamm, MD, Kerckhoff Clinic, Benekestrasse 2-8, 61321 Bad Nauheim, Germany.

Abstract

Troponins T and I are biochemical markers for thrombotic microembolization and minor myocardial injury and have proven to be sensitive prognostic indicators in patients with unstable angina. An analysis of data from the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) trial has shown that troponin-negative patients had a low incidence of cardiac events and did not benefit from glycoprotein (GP) IIb/IIIa receptor blockade. Abciximab significantly reduced both the short- and long-term risks of death or acute myocardial infarction in patients with baseline elevations in troponin. This has been confirmed in retrospective analyses of other trials. The combination of pre-treatment with a GP IIb/IIIa receptor antagonist with early invasive management was shown to provide the best outcome in the Thrombolysis and Counterpulsation to Improve Cardiogenic Shock Survival (TACTICS) study. Troponin measurements represent a practical and simple tool for risk stratifying patients with unstable angina and selecting those most likely to benefit from potent platelet inhibitor therapy.

Key Words: Troponin • GP IIb/IIIa • unstable angina • classification • risk stratification • myocardial infarction


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