EARLY ACS: Routine vs. delayed provisional use of eptifibatide may improve patient outcomes
Wang T. Circulation. 2011;123;722-730.
New data have shown that patients with non–ST-elevation acute coronary syndrome who used early eptifibatide besides clopidogrel before angiography had lower rates of 30-day mortality and MI compared with those who used eptifibatide on a delayed provisional basis.
Investigators of the Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome (EARLY-ACS) trial included 9,166 patients with non–ST-elevation ACS who underwent angiography, of which 7,068 patients received upstream clopidogrel (Plavix, Sanofi-Aventis).
At 96 hours after invasive strategy, 9.2% of patients who received early eptifibatide (Integrilin, Millennium/Schering) vs. 9.6% of patients treated with the delayed provisional strategy experienced the primary endpoint of death, MI, recurrent ischemia requiring urgent revascularization or thrombotic bailout, whereas at 30 days, the difference in the secondary endpoint in death or MI was slightly more pronounced in favor of early use (10.9% vs. 12.1%; adjusted HR=0.90).
Furthermore, a significant reduction in death or MI at 30 days was reported in patients receiving upstream clopidogrel who also received early eptifibatide vs. delayed provisional (adjusted OR=0.85, 95% CI 0.73-0.99), but not in patients without intended upstream clopidogrel use.
“These findings lend support to the concept of enhanced value for additive antiplatelet therapies,” the researchers concluded. “Future investigations are needed to identify those patients who may benefit from more intensive platelet inhibition without a significant excess in bleeding risk.”
EARLY ACS was funded by research grants from Schering-Plough and Merck Pharmaceuticals.
__________________________________________________ _______________________
CONNECT: Wireless remote monitoring ICDs, CRT-Ds significantly lowered length of hospital stay
Crossley G. J Am Coll Cardiol. 2011;57:1181-1189.
When compared with standard in-office care, patients treated with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators that featured wireless remote monitoring with automatic clinician alerts had significantly reduced mean length of hospital stay and time to a clinical decision, new data suggested.
As a result of these findings, the researchers wrote, “Clinics employing wireless remote monitoring may expect fewer total clinic visits per year while not increasing the rate of ED visits or CV hospitalizations for their patients.”
The Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision (CONNECT) trial included 1,997 patients from 136 clinical sites enrolled between November 2006 and May 2008. Each patient underwent insertion of an ICD or cardiac resynchronization therapy defibrillator (CRT-D) and were randomly assigned to either the remote monitoring arm (n=1,014) that utilized the Medtronic CareLink Network or the in-office arm (n=983).
During a follow-up of 15 months, the median time from clinical event to clinical decision was substantially reduced in the remote monitoring arm compared with the in-office arm (4.6 days vs. 22 days; P<.001). Also reduced in the remote monitoring group was the mean length of stay per CV hospitalization visit (3.3 days vs. 4 days; P=.002). Due to the reduction in length of stay, the estimated mean cost of hospitalization was considerably lower in the remote arm ($8,114 vs. $9,822).
|