Early use of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute XXXX : observations from the National Registry of @entity583 .

@entity1 @entity583 @entity1427
OBJECTIVES: We sought to identify @entity1 and hospital features associated with early glycoprotein (GP) IIb/IIIa inhibitor therapy for non-ST-elevation (NSTE) @entity583 ( @entity583 ) and to relate this treatment to in-hospital outcomes. BACKGROUND: Glycoprotein IIb/IIIa inhibitors have improved outcomes in randomized trials of @entity583 , leading national treatment guidelines to recommend their use. Their actual use, safety, and effectiveness have not been well characterized beyond trial populations. METHODS: We studied 60,770 @entity1 with @entity583 treated between July 2000 and July 2001 at 1,189 hospitals in a U.S. registry. Using logistic regression, we identified @entity1 and hospital features associated with @entity1427 /IIIa inhibition within 24 h after presentation. We also compared outcomes by early treatment versus no treatment after adjusting for @entity1 and hospital characteristics and treatment propensity. RESULTS: Only 25% of eligible @entity1 received early @entity1427 /IIIa therapy. Elderly @entity1 , @entity1 , minority @entity1 , and those without private insurance received such therapy less often than their counterparts. Treated @entity1 had lower unadjusted in-hospital mortality (3.3% vs. 9.6%, p < 0.0001) remaining significantly lower after adjustment for @entity1 risk, treatment propensity, and hospital characteristics (adjusted odds ratio, 0.88; 95% confidence interval, 0.79 to 0.97). Hospitals that adopted early @entity1427 /IIIa inhibition more rapidly also had lower adjusted mortality rates than those slower to adopt such therapy. CONCLUSIONS: Glycoprotein IIb/IIIa inhibitor therapy appears to be underused in early management of @entity583 @entity1 . Because this therapy is associated with better outcomes, it represents a target for quality improvement.
