The clinical role of platelet glycoprotein IIb/IIIa receptor inhibitors in ischemic heart disease
DONALD G. VIDT, MD
JEFFREY LEFKOVITS, MBBS
ERIC J. TOPOL, MDAddress reprint requests to E.J.T., Department of Cardiology, F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
The platelet glycoprotein (GP) IIb/IIIa receptor antagonists are powerful new antiplatelet drugs that show promise in reducing complications of coronary angioplasty and acute coronary syndromes.KEY POINTS
Platelets play a key role in the pathogenesis of ischemic heart disease. The platelet glycoprotein (GP) IIb/IIIa receptor binds fibrinogen and is the final common pathway leading to platelet aggregation. Compounds that inhibit the GP IIb/IIIa receptor have recently undergone extensive clinical evaluation. The Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) trial evaluated chimeric 7E3 Fab (c7E3), a monoclonal antibody to the GP IIb/IIIa receptor, in 2099 high-risk patients undergoing angioplasty. Patients treated with c7E3 had 35% fewer ischemic complications after angioplasty than did patients receiving placebo, although at the cost of increased bleeding. Patients with unstable angina or acute myocardial infarction or undergoing directional atherectomy derived particular benefit from c7E3 treatment. Treatment with c7E3 also reduced the 6-month rate of clinical restenosis and especially the number of repeat revascularizations. Several other peptide-based GP IIb/IIIa inhibitors have also been tested in pilot studies in patients with unstable angina and acute myocardial infarction, with positive results.