Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate- and high-risk acute coronary syndromes: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) substudy
Background Tirofiban and eptifibatide are both small-molecule, competitive glycoprotein IIb/IIIa receptor inhibitors (GPIs) that are guideline-supported for upstream therapy in acute coronary syndromes (ACS). This study sought to compare the efficacy and safety of tirofiban and eptifibatide in patie...
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| Veröffentlicht in: | The American heart journal 2014, Vol.167 (1), p.43-50 |
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| creator | Nazif, Tamim M., MD Mehran, Roxana, MD Lee, Edwin A.M., MD, PhD Fahy, Martin, MSc Parise, Helen, ScD Stone, Gregg W., MD Kirtane, Ajay J., MD, SM |
| description | Background Tirofiban and eptifibatide are both small-molecule, competitive glycoprotein IIb/IIIa receptor inhibitors (GPIs) that are guideline-supported for upstream therapy in acute coronary syndromes (ACS). This study sought to compare the efficacy and safety of tirofiban and eptifibatide in patients with ACS. Methods Within the ACUITY trial, 4,323 patients with moderate- and high-risk ACS received upstream, adjunctive GPI (tirofiban or eptifibatide) in addition to an antithrombin. Primary outcomes included 30-day rates of composite major adverse cardiac events (MACE), major bleeding (not related to coronary artery bypass grafting), and composite net adverse clinical events (NACE). The outcomes were compared based on the upstream GPI administered. Results There were significant differences in the baseline characteristics of patients treated with tirofiban vs eptifibatide, particularly related to country/region. In unadjusted analyses, treatment with upstream tirofiban vs eptifibatide was associated with similar rates of major bleeding (5.8% vs 6.5%, P = .39) and nonsignificantly lower rates of MACE (6.1% vs 7.6%, P = .06) and NACE (10.6% vs 12.6%, P = .06). After propensity-based multivariable adjustment, there were no significant differences between tirofiban and eptifibatide with respect to 30-day major bleeding, MACE, or NACE. Conclusions Among more than 4,000 patients with moderate- and high-risk ACS treated with upstream GPI as part of an early invasive management strategy, the use of tirofiban and eptifibatide resulted in similar clinical outcomes. These data suggest equivalence of these 2 agents for upstream use, while highlighting some of the difficulties of nonrandomized comparative effectiveness analyses, specifically the difficulty in addressing geographic differences in the use of nonrandomized treatments. |
| doi_str_mv | 10.1016/j.ahj.2013.10.013 |
| format | Article |
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This study sought to compare the efficacy and safety of tirofiban and eptifibatide in patients with ACS. Methods Within the ACUITY trial, 4,323 patients with moderate- and high-risk ACS received upstream, adjunctive GPI (tirofiban or eptifibatide) in addition to an antithrombin. Primary outcomes included 30-day rates of composite major adverse cardiac events (MACE), major bleeding (not related to coronary artery bypass grafting), and composite net adverse clinical events (NACE). The outcomes were compared based on the upstream GPI administered. Results There were significant differences in the baseline characteristics of patients treated with tirofiban vs eptifibatide, particularly related to country/region. In unadjusted analyses, treatment with upstream tirofiban vs eptifibatide was associated with similar rates of major bleeding (5.8% vs 6.5%, P = .39) and nonsignificantly lower rates of MACE (6.1% vs 7.6%, P = .06) and NACE (10.6% vs 12.6%, P = .06). After propensity-based multivariable adjustment, there were no significant differences between tirofiban and eptifibatide with respect to 30-day major bleeding, MACE, or NACE. Conclusions Among more than 4,000 patients with moderate- and high-risk ACS treated with upstream GPI as part of an early invasive management strategy, the use of tirofiban and eptifibatide resulted in similar clinical outcomes. These data suggest equivalence of these 2 agents for upstream use, while highlighting some of the difficulties of nonrandomized comparative effectiveness analyses, specifically the difficulty in addressing geographic differences in the use of nonrandomized treatments.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2013.10.013</identifier><identifier>PMID: 24332141</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Acute Coronary Syndrome - drug therapy ; Acute coronary syndromes ; Aged ; Angioplasty ; Cardiovascular ; Comparative Effectiveness Research ; Coronary Angiography ; Coronary vessels ; Drug therapy ; Female ; Heart attacks ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Peptides - therapeutic use ; Platelet Aggregation Inhibitors - therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors ; Propensity Score ; Treatment Outcome ; Tyrosine - analogs & derivatives ; Tyrosine - therapeutic use</subject><ispartof>The American heart journal, 2014, Vol.167 (1), p.43-50</ispartof><rights>Mosby, Inc.</rights><rights>2014 Mosby, Inc.</rights><rights>2014.</rights><rights>Copyright Elsevier Limited Jan 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-4a6e6c761dc8efaaa394f7251ce6a49f2d8c8141465494e8dafcedd59831bcbe3</citedby><cites>FETCH-LOGICAL-c436t-4a6e6c761dc8efaaa394f7251ce6a49f2d8c8141465494e8dafcedd59831bcbe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1547891537?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,4024,27923,27924,27925,45995,64385,64387,64389,72341</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24332141$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nazif, Tamim M., MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Lee, Edwin A.M., MD, PhD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD, SM</creatorcontrib><title>Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate- and high-risk acute coronary syndromes: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) substudy</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Tirofiban and eptifibatide are both small-molecule, competitive glycoprotein IIb/IIIa receptor inhibitors (GPIs) that are guideline-supported for upstream therapy in acute coronary syndromes (ACS). This study sought to compare the efficacy and safety of tirofiban and eptifibatide in patients with ACS. Methods Within the ACUITY trial, 4,323 patients with moderate- and high-risk ACS received upstream, adjunctive GPI (tirofiban or eptifibatide) in addition to an antithrombin. Primary outcomes included 30-day rates of composite major adverse cardiac events (MACE), major bleeding (not related to coronary artery bypass grafting), and composite net adverse clinical events (NACE). The outcomes were compared based on the upstream GPI administered. Results There were significant differences in the baseline characteristics of patients treated with tirofiban vs eptifibatide, particularly related to country/region. In unadjusted analyses, treatment with upstream tirofiban vs eptifibatide was associated with similar rates of major bleeding (5.8% vs 6.5%, P = .39) and nonsignificantly lower rates of MACE (6.1% vs 7.6%, P = .06) and NACE (10.6% vs 12.6%, P = .06). After propensity-based multivariable adjustment, there were no significant differences between tirofiban and eptifibatide with respect to 30-day major bleeding, MACE, or NACE. Conclusions Among more than 4,000 patients with moderate- and high-risk ACS treated with upstream GPI as part of an early invasive management strategy, the use of tirofiban and eptifibatide resulted in similar clinical outcomes. These data suggest equivalence of these 2 agents for upstream use, while highlighting some of the difficulties of nonrandomized comparative effectiveness analyses, specifically the difficulty in addressing geographic differences in the use of nonrandomized treatments.</description><subject>Acute Coronary Syndrome - drug therapy</subject><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Angioplasty</subject><subject>Cardiovascular</subject><subject>Comparative Effectiveness Research</subject><subject>Coronary Angiography</subject><subject>Coronary vessels</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Peptides - therapeutic use</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</subject><subject>Propensity Score</subject><subject>Treatment Outcome</subject><subject>Tyrosine - analogs & derivatives</subject><subject>Tyrosine - therapeutic use</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9Uktv1DAQjhCIlsIP4IIscSmHbO3EeYGEtFrxiFSJQ3cPnCzHmWy83dhb2ykKv5Ufw2S3gNQDp3n4m88z800UvWZ0wSjLr3YL2e8WCWUpxgs0T6JzRqsizgvOn0bnlNIkLguankUvvN9hmCdl_jw6S3iaJoyz8-jXyg4H6WTQ90Cg60DNngHvie3IePDBgRzIdj8pe3A2gDakrpuruq4l0abXjQ7WeXTJAUnABE9-6NCTwbaAtBATaVrS620fO-1viVRjAKKss0a6ifjJtM4O4N-TpSHL4-NKhh4COP0TGa05EmzcFrlJbTCP_R3za6flFshNmP_ZTuRyudrU6-_viB8bH8Z2ehk96-Tew6sHexFtPn9ar77G19--1Kvldax4moeYyxxyVeSsVSV0Usq04l2RZExBLnnVJW2pStwWzzNecShb2Slo26wqU9aoBtKL6PLEixu6G8EHMWivYL-XBuzoBeNFkWVJVeUIffsIurOjM9idYBkvyoplaYEodkIpZ7130ImD0wPuSzAqZunFTqD0YpZ-TqHBmjcPzGMzQPu34o_WCPhwAgCu4l6DE16hYDiKdii7aK3-L_3HR9Vqr41Wcn8LE_h_UwifCCpu5tubT4-llBYJK9LfMD_YqA</recordid><startdate>2014</startdate><enddate>2014</enddate><creator>Nazif, Tamim M., MD</creator><creator>Mehran, Roxana, MD</creator><creator>Lee, Edwin A.M., MD, PhD</creator><creator>Fahy, Martin, MSc</creator><creator>Parise, Helen, ScD</creator><creator>Stone, Gregg W., MD</creator><creator>Kirtane, Ajay J., MD, SM</creator><general>Mosby, Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>2014</creationdate><title>Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate- and high-risk acute coronary syndromes: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) substudy</title><author>Nazif, Tamim M., MD ; Mehran, Roxana, MD ; Lee, Edwin A.M., MD, PhD ; Fahy, Martin, MSc ; Parise, Helen, ScD ; Stone, Gregg W., MD ; Kirtane, Ajay J., MD, SM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-4a6e6c761dc8efaaa394f7251ce6a49f2d8c8141465494e8dafcedd59831bcbe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Coronary Syndrome - drug therapy</topic><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Angioplasty</topic><topic>Cardiovascular</topic><topic>Comparative Effectiveness Research</topic><topic>Coronary Angiography</topic><topic>Coronary vessels</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Peptides - therapeutic use</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</topic><topic>Propensity Score</topic><topic>Treatment Outcome</topic><topic>Tyrosine - analogs & derivatives</topic><topic>Tyrosine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nazif, Tamim M., MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Lee, Edwin A.M., MD, PhD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD, SM</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Physical Education Index</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Health Management</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nazif, Tamim M., MD</au><au>Mehran, Roxana, MD</au><au>Lee, Edwin A.M., MD, PhD</au><au>Fahy, Martin, MSc</au><au>Parise, Helen, ScD</au><au>Stone, Gregg W., MD</au><au>Kirtane, Ajay J., MD, SM</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate- and high-risk acute coronary syndromes: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) substudy</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2014</date><risdate>2014</risdate><volume>167</volume><issue>1</issue><spage>43</spage><epage>50</epage><pages>43-50</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Tirofiban and eptifibatide are both small-molecule, competitive glycoprotein IIb/IIIa receptor inhibitors (GPIs) that are guideline-supported for upstream therapy in acute coronary syndromes (ACS). This study sought to compare the efficacy and safety of tirofiban and eptifibatide in patients with ACS. Methods Within the ACUITY trial, 4,323 patients with moderate- and high-risk ACS received upstream, adjunctive GPI (tirofiban or eptifibatide) in addition to an antithrombin. Primary outcomes included 30-day rates of composite major adverse cardiac events (MACE), major bleeding (not related to coronary artery bypass grafting), and composite net adverse clinical events (NACE). The outcomes were compared based on the upstream GPI administered. Results There were significant differences in the baseline characteristics of patients treated with tirofiban vs eptifibatide, particularly related to country/region. In unadjusted analyses, treatment with upstream tirofiban vs eptifibatide was associated with similar rates of major bleeding (5.8% vs 6.5%, P = .39) and nonsignificantly lower rates of MACE (6.1% vs 7.6%, P = .06) and NACE (10.6% vs 12.6%, P = .06). After propensity-based multivariable adjustment, there were no significant differences between tirofiban and eptifibatide with respect to 30-day major bleeding, MACE, or NACE. Conclusions Among more than 4,000 patients with moderate- and high-risk ACS treated with upstream GPI as part of an early invasive management strategy, the use of tirofiban and eptifibatide resulted in similar clinical outcomes. These data suggest equivalence of these 2 agents for upstream use, while highlighting some of the difficulties of nonrandomized comparative effectiveness analyses, specifically the difficulty in addressing geographic differences in the use of nonrandomized treatments.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24332141</pmid><doi>10.1016/j.ahj.2013.10.013</doi><tpages>8</tpages></addata></record> |
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| subjects | Acute Coronary Syndrome - drug therapy Acute coronary syndromes Aged Angioplasty Cardiovascular Comparative Effectiveness Research Coronary Angiography Coronary vessels Drug therapy Female Heart attacks Humans Male Middle Aged Multivariate Analysis Peptides - therapeutic use Platelet Aggregation Inhibitors - therapeutic use Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors Propensity Score Treatment Outcome Tyrosine - analogs & derivatives Tyrosine - therapeutic use |
| title | Comparative effectiveness of upstream glycoprotein IIb/IIIa inhibitors in patients with moderate- and high-risk acute coronary syndromes: An Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) substudy |
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