New platelet inhibitors for acute coronary syndromes without ST elevation

Journal of Clinical and Basic Cardiology 2000; 3 (2): 107-110

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Keywords: instabile Angina pectoris,  Myokardinfarkt,  Plättchen,  Risikostratifizierung,  Studie,  clinical trials,  myocardial infarction,  platelets,  risk stratification,  unstable angina

Acute coronary syndromes including myocardial infarction and unstable angina are common medical emergencies that carry a high burden of morbidity and mortality. There are about one million admissions for acute coronary syndromes each year in Western Europe and the associated cost amounts to 1-2 % of total health care expenditure. Acute coronary syndromes without ST elevation of the presenting ECG are increasingly recognised as carrying a high risk with about 30 % of patients suffering death, new myocardial infarction, refractory angina or readmission for unstable angina over a 6 month period from the initial hospital admission. Recent therapeutic developments to treat acute coronary syndromes include the glycoprotein 2b/3a receptor antagonists that inhibit platelet aggregation. Tirofiban and eptifibatide are two glycoprotein 2b/3a receptor antagonists that have been investigated in well-conducted randomised trials and approved for treating acute coronary syndromes without ST elevation. On average they produce proportional reductions in the rate of death or new myocardial infarction of 30-40 % over the first few days and 15-20 % at 6 months, with absolute reductions of about 2-3 %. Preliminary health economic evaluations suggest that using these new agents to treat higher risk patients adds only a modest cost while helping to avoid substantial numbers of adverse outcomes. The meaningful therapeutic effects observed in clinical trials should help to reduce the burden of disability in acute coronary syndromes if glycoprotein 2b/3a receptor antagonists are used in routine practice. J Clin Basic Cardiol 2000; 3: 107-10.