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Review
. 2001;28(4):276-87.

Unstable angina and non-ST-segment elevation myocardial infarction: perspectives on combination therapy

R P Villareal  1 , P Kim, J J Ferguson 3rd, J M Wilson
Affiliations
Review

Unstable angina and non-ST-segment elevation myocardial infarction: perspectives on combination therapy

R P Villareal et al. Tex Heart Inst J. 2001.

Abstract

We reviewed recent clinical data on the management of unstable angina and non-ST segment elevation myocardial infarction. We concentrated on the use of new therapies, particularly in combination with both older agents and other new methods, in order to present health care providers with an overview of available treatment options. The clinical trials reviewed herein provide strong evidence and proof of principle that combination therapies targeting 1) platelet function (aspirin, thienopyridines, and GP IIb/IIIa antagonists), 2) the coagulation cascade (unfractionated heparin and low-molecular-weight heparin), and 3) the physical characteristics of the active lesion (percutaneous intervention) reduce the risk of death or ischemic complications after thrombotic progression of coronary atherosclerosis.

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Figures

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Fig. 1 Kaplan-Meier curves depicting the cumulative incidence of death or myocardial infarction in patients randomized to GP IIb/IIIa antagonism (bold line) or placebo. Data were derived from CAPTURE, PURSUIT, and PRISM-PLUS. Left: Event rates during the initial period of medical treatment until the moment of percutaneous coronary intervention (PCI) or coronary artery bypass grafting, if any. Right: Event rates among PCI patients during 48-hour period after the procedure. At the beginning of each period, event rates were reset to 0. (Adapted from Boersma E, Akkerhuis KM, Theroux P, Califf RM, Topol EJ, Simoons ML. Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation 1999;100:2045–8. Published with permission from Lippincott Williams & Wilkins and from the author.)
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