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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

References

  1. Heeschen C, Hamm CW, Bruemmer J, Simoons ML, CAPTURE Investigators. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. J Am Coll Cardiol. 2000;35:1535–1542[Abstract/Free Full Text]
  2. Lincoff AM, Califf RM, Anderson KM, et al. Evidence for prevention of death and myocardial infarction with platelet membrane glycoprotein IIb/IIIa receptor blockade by abciximab (c7E3 Fab) among patients with unstable angina undergoing percutaneous coronary revascularization. J Am Coll Cardiol. 1997;30:149–156[Abstract]
  3. The CAPTURE Investigators. Randomised placebocontrolled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet. 1997;349:1429–1435[CrossRef][Web of Science][Medline]
  4. Simoons M. Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IV-ACS). Presented at the 22nd Annual Congress of the European Society of Cardiology. August 26–30, 2000. Amsterdam, The Netherlands
  5. RESTORE Investigators. Effects of platelet glycoprotein IIb/ IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation. 1997;96:1445–1453[Abstract/Free Full Text]
  6. Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Study Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. N Engl J Med. 1998;338:1498–1505[Abstract/Free Full Text]
  7. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med. 1998;338:1488–1497[Abstract/Free Full Text]
  8. PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med. 1998;339:436–443[Abstract/Free Full Text]
  9. Heeschen C, Hamm CW, Goldmann B, Deu A, Langenbrink L, White HD, PRISM Study Investigators. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. Lancet. 1999;354:1757–1762[CrossRef][Web of Science][Medline]
  10. Heeschen C, van den Brand ML, Hamm CW, Simoons ML, CAPTURE Investigators. Angiographic findings in patients with refractory unstable angina according to troponin T status. Circulation. 1999;104:1509–1514
  11. Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102:118–122[Abstract/Free Full Text]
  12. van Domburg RT, Cobbaert C, Kimman G-J, Zerback R, Simoons ML. Long-term prognostic value of serial troponin T bedside tests in patients with acute coronary syndromes. Am J Cardiol. 2000;86:623–627[CrossRef][Web of Science][Medline]
  13. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992;327:146–150[Abstract]
  14. Lindahl B, Venge P, Wallentin L, FRISC Study Group. Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease. Circulation. 1996;93:1651–1657[Abstract/Free Full Text]
  15. Säfström K, Lindahl B, Swahn E, FRISC-Study Group. Risk stratification in unstable coronary artery disease: exercise test and troponin T from a gender perspective. J Am Coll Cardiol. 2000;35:1791–1800[Abstract/Free Full Text]
  16. Lindahl B, Andren B, Ohlsson J, Venge P, Wallentin L, FRISC Study Group. Risk stratification in unstable coronary artery disease: additive value of troponin T determi nations and pre-discharge exercise tests. Eur Heart J. 1997;18:762–770[Abstract/Free Full Text]
  17. Amman EM, Tanasijevic ML, Thompson B, et al. Cardiacspecific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335:1342–1349[Abstract/Free Full Text]
  18. Hamm CW, Goldmann BU, Heeschen C, Kreyman G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med. 1997;337:1648–1653[Abstract/Free Full Text]
  19. deFilippi CR, Tocchi M, Parmar RJ, et al. Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes: angiographic correlates and long-term clinical outcomes. J Am Coll Cardiol. 2000;35:1827–1834[Abstract/Free Full Text]
  20. Braunwald E. Unstable angina: a classification. Circulation. 1989;80:410–414[Free Full Text]
  21. Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation. 1985;71:699–708[Abstract/Free Full Text]
  22. Davies MJ, Thomas AC. Plaque fissuring: the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J. 1985;53:363–373[Free Full Text]
  23. Davies ML, Thomas AC, Knapman PA, Hangartner JR. Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation. 1986;73:418–427[Abstract/Free Full Text]
  24. Farb A, Burke AP, Tang AL, et al. Coronary plaque erosion without rupture into a lipid core: a frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354–1363[Abstract/Free Full Text]
  25. Davies MJ. The composition of coronary-artery plaques. N Engl J Med. 1997;336:1312–1313[Free Full Text]
  26. Mizuno K, Satomura K, Miyamoto A, et al. Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med. 1992;326:287–291[Abstract]
  27. Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med. 1999;340:1623–1629[Abstract/Free Full Text]
  28. Cannon CP, The TACTICS study. Presented at the American Heart Association Meeting. November 12–15, 2000. New Orleans, LA, U.S.A.

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