C-3. Clinical trial updates: GP IIb/IIIa inhibitors Proposed model for optimal use of GP IIb/IIIa inhibitors Content Points: The clinical efficacy of GP IIb/IIIa inhibitors is related to the level of platelet inhibition.1 Maximum efficacy at time of PCI occurs when >80% inhibition is achieved. However, prolonged exposure to lesser levels of platelet inhibition in the absence of early revascularization may induce platelet P-selectin expression, thereby enhancing inflammation. This model suggests that exposure to low levels of platelet inhibition (as occurred during trials of oral GP IIb/IIIa inhibitors) or use of suboptimal intravenous (IV) doses may be proinflammatory and prothrombotic. 1 Quinn MJ, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa inhibitors: Recognition of a two-edged sword? Circulation. 2002;106:379-385.

GP IIb/IIIa inhibitors: Benefit related to revascularization strategy Content Points: Roffi et al performed a meta-analysis of randomized trials of GP IIb/IIIa inhibitors in patients with non-ST-elevation ACS.1 As shown, they found that patients undergoing PCI while receiving a GP IIb/IIIa inhibitor derived significant benefit. Patients who underwent PCI following discontinuation of a GP IIb/IIIa inhibitor derived a lesser benefit, which did not reach statistical significance. Patients who were managed medically without an interventional procedure derived only marginal benefit. 1 Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy. Eur Heart J. 2002;23:1441-1448.

GP IIb/IIIa inhibitors: Events prevented and number-needed-to-treat by management strategy Content Points: Antman1 used the data from Roffi et al2 (discussed on the previous slide) to quantify the treatment effects of GP IIb/IIIa inhibitors according to revascularization strategy. The number of events (death or MI) prevented per 1000 patients treated: Patients undergoing PCI while receiving a GP IIb/IIIa inhibitor: 30 Patients who undergo PCI following discontinuation of a GP IIb/IIIa inhibitor: 14 Patients who are managed medically: 4 The number of patients needed to treat to prevent one event (death or MI): Patients undergoing PCI while receiving a GP IIb/IIIa inhibitor: 32 Patients who undergo PCI following discontinuation of a GP IIb/IIIa inhibitor: 71 Patients who are managed medically: 250 1 Antman EM. 'I can see clearly now': A new view on the use of IV GP IIb/IIIa inhibitors in acute coronary syndromes. Eur Heart J. 2002;23:1408-1411. 2 Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy. Eur Heart J. 2002;23:1441-1448.