TY - JOUR
T1 - Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation
T2 - Effect of inhibition of platelet glycoprotein IIb/IIIa with eptifibatide
AU - Hasdai, David
AU - Holmes, David R.
AU - Criger, Douglas A.
AU - Topol, Eric J.
AU - Califf, Robert M.
AU - Wilcox, Robert G.
AU - Paolasso, Ernesto
AU - Simoons, Maarten
AU - Deckers, Jaap
AU - Harrington, Robert A.
PY - 2000
Y1 - 2000
N2 - Background: Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers. Methods: The study population included patients enrolled in the PURSUIT trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) with known smoking status presenting with ischemic chest pain ≤24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels. Patients were randomly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to standard therapy. The primary end point was a composite of death or nonfatal myocardial infarction within 30 days. Results: Of the 9406 patients with known smoking status, 2677 were current smokers, 3086 were former smokers, and 3643 were nonsmokers. Cigarette smokers had better 30-day outcomes (12.3%, 16.8%, and 15.4% for smokers, former smokers, and nonsmokers, respectively; P = .001). However, after adjusting for differences in baseline clinical variables, smoking status was not a predictor of 30-day outcome (P = .45). There was a reduction in the composite end point overall with eptifibatide compared with placebo (14.3% vs 15.7%, P = .054) but no interaction between smoking status and treatment strategy (P = .68). Conclusions: Among patients with ACS without persistent ST-segment elevation, cigarette smokers had better short-term outcomes because of their more favorable clinical profile. Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers, eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers.
AB - Background: Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes (ACS) and have platelet-rich coronary thrombi. We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers. Methods: The study population included patients enrolled in the PURSUIT trial (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) with known smoking status presenting with ischemic chest pain ≤24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels. Patients were randomly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to standard therapy. The primary end point was a composite of death or nonfatal myocardial infarction within 30 days. Results: Of the 9406 patients with known smoking status, 2677 were current smokers, 3086 were former smokers, and 3643 were nonsmokers. Cigarette smokers had better 30-day outcomes (12.3%, 16.8%, and 15.4% for smokers, former smokers, and nonsmokers, respectively; P = .001). However, after adjusting for differences in baseline clinical variables, smoking status was not a predictor of 30-day outcome (P = .45). There was a reduction in the composite end point overall with eptifibatide compared with placebo (14.3% vs 15.7%, P = .054) but no interaction between smoking status and treatment strategy (P = .68). Conclusions: Among patients with ACS without persistent ST-segment elevation, cigarette smokers had better short-term outcomes because of their more favorable clinical profile. Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers, eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers.
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U2 - 10.1016/S0002-8703(00)90089-9
DO - 10.1016/S0002-8703(00)90089-9
M3 - Article
C2 - 10689260
AN - SCOPUS:0034015678
VL - 139
SP - 454
EP - 460
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 3
ER -