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An editorial discusses the potential of drug-coated balloons (DCBs) as a treatment for in-stent restenosis in coronary artery disease. It highlights the AGENT IDE study, the first U.S. trial evaluating DCBs, which showed superiority over conventional balloons in reducing adverse events. It notes that using noncoated balloons as the control may not reflect current practice.

The University of Kentucky College of Medicine and Albert B. Chandler Hospital opened over 50 years ago to serve Kentucky. After initial growth and expansion, both were struggling clinically, academically, and financially in the early 2000s. Difficulties were apparent in cardiovascular (CV) services, which captured only 11% of the regional patients hospitalized for cardiac disease. Over the next 15 years, CV services dynamically transformed to become the leading provider with a large network of regional partners, garnering 42% of market share. This article describes strategic plans and initiatives leading to clinical and academic growth. Future value-based initiatives are also described. [ABSTRACT FROM AUTHOR]

The role of percutaneous coronary interventions in addition to medical therapy for patients with stable coronary artery disease continues to be debated in routine clinical practice, despite more than 2 decades of randomized controlled trials. The residual uncertainty arises from particular challenges facing revascularization trials. Which endpoint do doctors care about, and which do patients care about? Which participants should be enrolled? What background medical therapy should we use? When is placebo control relevant? In this paper, we discuss how these questions can be approached and examine the merits and disadvantages of possible options. Engaging multiple stakeholders, including patients, researchers, regulators, and funders, to ensure the design elements are methodologically valid and clinically meaningful should be an aspirational goal in the development of future trials. [ABSTRACT FROM AUTHOR]

The article focuses on the results of the TAILOR-PCI randomized study examining a clinical decision strategy that depends on CYP2C19 genotyping to guide antiplatelet drug assignment following percutaneous coronary interventions. Study subjects received clopidogrel without initial genetic testing while another group of subjects received clopidogrel versus ticagrelor or prasugel. It suggests the use of a personalized medicine approach that involved genotyping for therapeutic interventions.

The authors comment on a Japanese study that examined iterations of shorter-duration dual antiplatelet therapy (DAPT) in patients in Japan who received everolimus-eluting stents by discontinuing aspirin instead of the P2Y12 inhibitor as has commonly been the approach. They compare the findings of the study with those of a similar study in Korea that involved patients who received a current-generation drug-eluting stent. They also discuss the possible impact of the results on clinical practice.

(J Interven Cardiol 2010;23:565-568) [ABSTRACT FROM AUTHOR]

The article presents a randomised controlled study that assessed the tolerability and safety of the oral platelet protease-activated receptor-1 antagonist SCH530348. The study was conducted in response to the need for an antithrombotic drug that safely reduces cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). Patients undergoing non-urgent PCI or coronary anigography with planned PCI were randomly assigned to SCH 530348 or matching placebo. The incidence of clinically significant major or minor bleeding according to the thrombolysis in myocardial infarction scale was the primary endpoint. Researchers found that SCH 530348 was well tolerated and did not cause increased thrombolysis in myocardial infarction (TIMI) bleeding.

Platelet adhesion, activation, and aggregation at sites of vascular endothelial disruption caused by atherosclerosis are key events in arterial thrombus formation. Platelet tethering and adhesion to the arterial wall, particularly under high shear forces, are achieved through multiple high-affinity interactions between platelet membrane receptors (integrins) and ligands within the exposed subendothelium, most notably collagen and von Willebrand factor (vWF). Platelet adhesion to collagen occurs both indirectly, via binding of the platelet glycoprotein (GP) Ib-V-IX receptor to circulating vWF, which binds to exposed collagen, and directly, via interaction with the platelet receptors GP VI and GP Ia/IIb. Platelet activation, initiated by exposed collagen and locally generated soluble platelet agonists (primarily thrombin, ADP, and thromboxane A2), provides the stimulus for the release of platelet-derived growth factors, adhesion molecules and coagulation factors, activation of adjacent platelets, and conformational changes in the platelet αIIbβ3 integrin (GP IIb/IIIa receptor). Platelet aggregation, mediated primarily by interaction between the activated platelet GP IIb/IIIa receptor and its ligands, fibrinogen and vWF, results in the formation of a platelet-rich thrombus. Currently available antiplatelet drugs (aspirin [acetylsalicylic acid], dipyridamole, clopidogrel, ticlopidine, abciximab, eptifibatide, tirofiban) act on specific targets to inhibit platelet activation and aggregation. Elucidation of the multiple mechanisms involved in platelet thrombus formation provides opportunities for selectively inhibiting the pathways most relevant to the pathophysiology of atherothrombosis. [ABSTRACT FROM AUTHOR]

: ObjectivesWe sought to examine if clopidogrel treatment initiated before coronary stenting improved clinical outcomes among patients receiving aspirin and a glycoprotein (GP) IIb/IIIa inhibitor.: BackgroundAntiplatelet therapy plays a pivotal role in contemporary percutaneous coronary interventions (PCI).: MethodsOutcomes among 4,809 patients randomized to tirofiban or abciximab during PCI with stent placement were compared according to whether they received 300 mg of clopidogrel before PCI (93.1%) versus immediately after the procedure.: ResultsThe 30-day primary composite end point (death, myocardial infarction [MI], or urgent target vessel revascularization [TVR]) was lower among clopidogrel-pretreated patients (6.6% vs. 10.4%, p = 0.009), mainly because of reduction of MI (6.0% vs. 9.5%, p = 0.012). The benefit of clopidogrel pretreatment was sustained at six months (death, MI, any TVR: 14.6% vs. 19.8%, HR = 0.71, p = 0.010), and this was due mainly to lowering of death and MI (7.8% vs. 13.0%, p = 0.001). At one year, clopidogrel pretreatment was associated with a lower mortality rate (1.7% vs. 3.6%, p = 0.011). Because clopidogrel pretreatment was not randomized, multivariable and propensity analyses were performed. After adjusting for baseline heterogeneity, clopidogrel pretreatment was an independent predictor for death or MI at 30 days (HR = 0.63, p = 0.012) and at six months (HR = 0.61, p = 0.003), and survival at one year (HR = 0.53, p = 0.044). No excess in 30-day bleeding events was noted with clopidogrel pretreatment.: ConclusionsAmong patients undergoing coronary stent placement with aspirin and a GP IIb/IIIa inhibitor, clopidogrel pretreatment is associated with a reduction of death and MI irrespective of the type of GP IIb/IIIa inhibitor used. [Copyright &y& Elsevier]

: ObjectivesThe aim of this study was to discern a target range of anticoagulation for enoxaparin during percutaneous coronary intervention (PCI) as measured by the Rapidpoint ENOX (Pharmanetics Inc., Morrisville, North Carolina), a new point-of-care test.: BackgroundIn the U.S., enoxaparin has been used in only a small proportion of PCI procedures, partly because a rapid enoxaparin-specific assay was unavailable.: MethodsWe analyzed data from 445 enrolled patients receiving subcutaneous or intravenous enoxaparin in a prospective, multicenter study. Serial anticoagulation measurements and clinical outcomes were recorded.: ResultsThe in-hospital composite occurrence of death, myocardial infarction, and urgent target vessel revascularization was 5.4%, and Thrombolysis In Myocardial Infarction (TIMI) major bleeding, minor bleeding, and any reported bleeding occurred in 0.2%, 1.3%, and 7.9% of patients, respectively. No significant association between procedural ENOX times and ischemic events was observed (p = 0.222), although the event rate was 4.0% among those with ENOX times between 250 to 450 s versus 7.2% for those outside this range (p = 0.134). Increasing ENOX time at sheath removal was correlated with any bleeding (p = 0.010) with a 1% increase for every ∼30-s rise.: ConclusionsIschemic events were infrequent, and the rate appeared lowest in the mid-range of ENOX times. Bleeding events increased with increasing ENOX times. These observations, combined with a suggested procedural anti-Xa level of 0.8 to 1.8 IU/ml, translate into a recommended ENOX time range of 250 to 450 s for PCI and <200 to 250 s for sheath removal. [Copyright &y& Elsevier]

SUMMARY BACKGROUND: Two placebo-controlled trials testing intravenous platelet glycoprotein IIb/IIIa antagonists in the setting of percutaneous coronary revascularisation with intracoronary stents have shown a durable reduction in ischaemic events to 6 months. These trials differed regarding their patient population, IIb/IIIa inhibitor, and reported extent of benefit. Whether a small-molecule agent affecting only the IIb/IIIa receptor would provide a similar outcome for ischaemic events and clinical restenosis at 6 months when directly compared with a monoclonal antibody known to affect several integrin receptors is unknown. METHODS: In 18 countries at 149 hospitals, 4809 patients undergoing elective or urgent stent implantation were randomly assigned a bolus and infusion of tirofiban or abciximab. Patients were followed for 6 months for the occurrence of death, myocardial infarction, and any target-vessel revascularisation. The results at 30 days have been reported previously. FINDINGS: At 6 months the composite endpoint of death, myocardial infarction, and target-vessel revascularisation occurred in 356 (14.8%) patients who received tirofiban and 345 (14.3%) patients who received abciximab (hazard ratio 1.04, 95% CI 0.90-1.21; p=0.591). The rates for the individual endpoints were 191 (8.0%) versus 159 (6.6%) for myocardial infarction (hazard ratio 1.21, 95% CI 0.98-1.50; p=0.074), 26 (1.1%) versus 25 (1.0%) for death (1.04, 0.60-1.80; p=0.893), and 194 (8.1%) versus 208 (8.6%) for target-vessel revascularisation (0.93, 0.77-1.14; p=0.495). INTERPRETATION: At 6 months, tirofiban provided a similar level of overall protection to abciximab against the composite of death, myocardial infarction, and any target-vessel revascularisation. [ABSTRACT FROM AUTHOR]

Platelet function tests measure different aspects of platelet function, which include adherence, activation, aggregation and secretion. Clinically, the goal of platelet function testing is to provide information about the platelet contribution to the risk of thrombotic or haemorrhagic events and the optimisation of antiplatelet therapy. The important clinical questions are whether an antiplatelet agent is having the desired effect on platelet inhibition (effectiveness) and whether the patient has sufficient residual platelet function to avoid bleeding (safety). The role of aspirin (acetylsalicylic acid) and thienopyridines is well established in the management of patients with coronary artery disease and in the setting of coronary interventions. The last several years have demonstrated the unequivocal effectiveness of intravenously administered platelet glycoprotein (GP) IIb/IIIa antagonists in the management of acute coronary syndromes and in the setting of percutaneous coronary interventions. With the increasing use of these GPIIb/IIIa antagonists, it is becoming more important clinically to measure platelet inhibition with these agents. This paper reviews major techniques and instrumentation for platelet monitoring and discusses the goals of the best method. [ABSTRACT FROM AUTHOR]

Treatment for ST-elevation myocardial infarction (MI) has advanced rapidly in the last few years with improvements in early fibrinolytic therapy, primary percutaneous revascularization, and use of potent platelet glycoprotein IIb/IIIa inhibitors. It is now obvious that establishing epicardial patency after myocardial infarction is not synonymous with tissue-level perfusion. Techniques and therapies are now available that measure true tissue-level perfusion and that may improve tissue-level perfusion after myocardial infarction. [ABSTRACT FROM AUTHOR]

Few data are available in prospectively collected cohorts of patients with unstable angina pectoris or on the use of appropriate medications or interventions. Accordingly, we evaluated 2,948 consecutive patients with unstable angina admitted to 35 hospitals in the United States in 1996, and comparing men and women (39% of the patients were women). Differences were seen in coronary risk profiles with a higher incidence of systemic hypertension, diabetes mellitus, and a family history of coronary disease in women. Women were less likely to receive Agency for Health Care Policy Research (AHCPR) recommended pharmacologic treatment than men. Cardiac catheterization, coronary angioplasty, and bypass was performed less often in women compared with men (44% vs. 53%, p = 0.002; 12% vs. 18%, p = 0.02; 7% vs. 10%, p = 0.001, respectively). At catheterization, women were more likely to have no significant coronary artery disease (25% vs. 14%, p = 0.001). Although fewer women than men fulfilled the AHCPR criteria for cardiac catheterization (54% vs. 64%, p = 0.001), a similar rate of men and women with positive criteria underwent catheterization and angioplasty. However, fewer women with positive criteria underwent bypass surgery (36% vs. 46%, p = 0.03). More men "ruled-in" for a myocardial infarction at admission (13% vs. 8%, p = 0.001), but there was no difference in recurrent angina, in-hospital myocardial infarction, or death. Despite different epidemiologic profiles and less evidence of coronary artery disease by noninvasive and invasive tests, women and men had similar outcomes. [ABSTRACT FROM AUTHOR]

Assesses the influence of cocaine on the plasma constituents involved in endogenous thrombosis and thrombolysis. Procurement of blood samples in 22 patients undergoing cardiac catheterization after the administration of intranasal saline or cocaine; Measurement of the plasma concentrations of fibrinogen, plasminogen and lipoprotein(a).

The article discusses research done on the value of troponin in the management of non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). It references a study L. Wallentin and colleagues which investigated the role of troponin in assessing the benefit of ticagrelor and clopidogrel, published within the issue. It is suggested that the study has provided additional evidence to support an aggressive approach for the management of definite NSTE-ACS.

The authors reflect on patient self-directed care strategy for long-term anticoagulation with warfarin therapy. They relate on the meta-analysis by H. E. Bloomfield and colleagues which shows that self-care strategy using international normalized ratio (INR) testing for long-term anticoagulant treatment is safer when compared to clinic-based strategy. They mention the cost benefits of The Home INR Study (THINRS) by D. B. Matchar and colleagues and patient self-testing (PST) with usual care.

The authors discuss the effectiveness of percutaneous coronary intervention (PCI) for patients with non-acute coronary artery disease, referring to a study by Thomas Trikalinos and colleagues that examined PCI and medical therapy. They believe the results of the study should be unsurprising. They note that prevention of secondary vascular disease can be effective and that clinicians should treat the underlying artherosclerotic process with lifestyle modifications and drugs.

The authors delve into the coupling of revascularization after thrombolysis for myocardial infarction. Various studies providing analyses between primary percutaneous coronary intervention (PCI) and thrombolytic therapy have shown that patients treated with PCI have lower short-term mortality rates, less hemorrhagic stroke, and have higher risk for major bleeding. An overview of a study of non-randomized method of thrombolytic therapy for ST-segment elevation myocardial infarction is provided.

The editorial focuses on target vessel revascularization (TVR) and in-stent restenosis (ISR). The results of clinical trials, such as TAXUS V ISR whose patients had paclitaxel-eluting stents and Sirolimus-Eluting Stent with Vascular Brachytherapy for the Treatment of In-Stent Restonisis (SISR), indicate outcomes from drug-eluting stent implantation are better than those using brachytherapy. The author suggests methods for further research.

Presents an editorial regarding the treatment of ischemic heart disease for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. Description of a study conducted by the Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction investigators; Trial in which patients receiving thrombolytic therapy received a dose of either clopidogrel or placebo; Reference to a study by Sabatine et al. in the September 14, 2005 issue of the journal regarding clopidogrel pretreatment.

The baseline characteristics, complications, and survival of 489 black and 6,890 non-black patients with acute coronary syndromes were studied. Important racial differences were observed in demographic features, atherosclerosis risk factors, and treatment strategies; however, despite these differences, no independent difference was observed in clinical outcomes according to race. The 1-year mortality rate was 2.9% for black patients and 2.5% for non-black patients (p = 0.93). [Copyright &y& Elsevier]

Presents an editorial about fractionating heparins. Use of heparins in reducing ischemic events beyond that of aspirin alone in the setting of an acute coronary syndrome; Limitations of unfractionated heparins; Description of enoxaparin, a low-molecular-weight heparin; Results of clinical trials of enoxaparin; Reference to studies in this issue focusing on enoxaparin trials; Assertion that enoxaparin is an effective, noninferior alternative to unfractionated heparin for treatment of acute coronary syndrome.

Assesses the influence of Labetalol on cocaine-induced coronary vasoconstriction. Cocaine and cardiovascular complications; Limitations of the study.

The authors reflect on the possible risk of the addition of nonsteroidal anti-inflammatory drugs (NSAID) to antithrombotic therapy following myocardial infarction. They claim that NSAIDs work by blocking prostaglandin and prostacyclin biosynthesis through their inhibition of cyclooxygenase (COX) enzymes. They present the study by Schjerning Olsen and colleagues on the effect of NSAID to antithrombotic therapy after myocardial infarction.

The author reflects on the evidence that percutaneous coronary interventions (PCI) reduce the risk of myocardial infarction and death in patients with acute coronary syndromes but these benefits have not been established for patients with stable coronary artery disease. Topics discussed include a report by Windecker and colleagues that compares the outcomes of patients with stable disease who were assigned to initial medical treatment or medical treat plus coronary artery revascularisation.

The authors reflect on the role of tissue necrosis factor-alpha (TNF-Alpha) and targeting its receptor in ischemic heart disease. They state that elevated concentration of TNF-alpha, which is produced by macrophages and lymphocytes, affects the patients of ischemic heart disease, acute myocardial infarction (AMI) and decompensate heart failure. They also state that TNF-alpha antagonism is beneficial in AMI patients with increasing platelet activation and absence of vasodilatation.

This editorial comments on a study in this issue which compared two drug-eluting stents and found little difference in their efficacy. Although the study did not find much difference, the authors say a meta-analysis of 38 trials suggested that the sirolimus-eluting stents were better than the paclitaxel-eluting stents. Physicians will have to choose which stent to use based on multiple factors such as safety, availability, cost and effectiveness.

Presents a letter to the editor about fractionating heparin.

Editorial. Discusses the cardiac isoforms of troponin I (cTnI) and T (cTnT), which are markers of acute coronary syndrome (ACS). Reference to an article in the same issue by Morrow et al; Suggestion that the findings of Morrow support an early invasive strategy for troponin-positive patients with ACS; Problems with cTnI and cTnT assays, both laboratory based and point-of-care based.

Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53–1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34–0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45–0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38–0.70). BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure. • This analysis included >7000 ACS patients undergoing PCI from two RCTs • Biolimus-eluting stents (BES) were compared to other limus-eluting stent (LES) • BES were associated with fewer myocardial infarction than other LES at 1-year • BES were associated with fewer repeated revascularization than other LES at 1-year • Further randomized data are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Question In patients with an acute coronary syndrome (ACS) referred for an early invasive strategy, does double-dose clopidogrel or higher-dose aspirin prevent cardiovascular (CV) events? Methods Design 2 x 2 factorial, randomized controlled trial (Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events -- Seventh Organization to Assess Strategies in Ischemic Syndromes [CURRENT-OASIS 7] trial). ClinicalTrials.gov NCT00335452. Allocation Concealed.* Blinding Blinded {clopidogrel: patients, clinicians delivering the interventions, outcome assessors, data analysts; aspirin: outcome adjudicators}†.* Follow-up period 30 days. Setting {597 centers in 39 countries}†. Patients 25>086 patients >18 years of age (mean age 61 y, 73% men) who presented with a non-ST-segment elevation ACS or ST-segment elevation myocardial infarction (MI) and either electrocardiographic ischemic changes or elevated levels of cardiac biomarkers. Eligible patients required coronary angiography and percutaneous coronary intervention (PCI) within 72 hours of randomization. Exclusion criteria included increased risk for bleeding, active bleeding, and known allergy to study drugs. Intervention Double-dose clopidogrel, 600 mg on day 1 before coronary angiography and 150 mg/d on days 2 to 7 (n =>12>520), or standard-dose clopidogrel, 300 mg on day 1 and 75 mg/d on days 2 to 7 (n =>12>566). All patients received clopidogrel, 75 mg/d, on days 8 to 30. Patients were also randomized to higher-dose aspirin, 300 to 325 mg/d (n =>12>507), or lower-dose aspirin, 75 to 100 mg/d (n =>12>579) on days 2 to 30. All patients received >300 mg aspirin on day 1. Outcomes Primary efficacy outcome was a composite of CV death, MI, or stroke. Secondary outcomes included a composite of CV death, MI, stroke, or recurrent ischemia. Primary safety outcome was major bleeding. The trial had 80% power to detect a relative hazard reduction of 15.8% with double-dose clopidogrel, assuming a 4.5% event rate in the standard-dose group. Patient follow-up 99.9%. Main results The main results are in the Table. Conclusion In patients with an acute coronary syndrome referred for an early invasive strategy, neither double-dose clopidogrel nor higher-dose aspirin prevented cardiovascular events. [ABSTRACT FROM AUTHOR]

Platelet activation and thrombin formation play significant roles in the pathophysiology of acute coronary syndrome. To overcome this pathophysiology, antiplatelet agents are utilized to decrease platelet aggregation and anticoagulants to decrease thrombin formation. Current antiplatelet agents are designed to inhibit various mediators of platelet activation, such as thromboxane A2 and adenosine diphosphate, and platelet-surface receptors (e.g., glycoprotein IIb/IIIa receptors). The rationale for upstream versus deferred administration of antiplatelet therapy in patients scheduled for percutaneous intervention and the current ACC/AHA guidelines for the management of patients with unstable angina/non-ST-segment myocardial infarction are discussed. The next-generation antiplatelet drugs are in various stages of clinical development, with unique differentiating mechanistic and pharmacokinetic properties. The newer P2Y12 thienopyridine receptor antagonists and protease receptor inhibitor are also examined, in addition to the rationale of various outcome studies evaluating the efficacy and safety of the different agents. [ABSTRACT FROM AUTHOR]

A response by David J. Moliterno to a letter to the editor about his article related to drug-eluting coronary stents in a previous issue is presented.

The article presents the author's opinion on the effectiveness of the placement of a coronary-artery stent that has emerged as the technique of choice for percutaneous coronary intervention restenosis. According to the author, the technique provides a substantial reduction in the percentage of patients who need subsequent target-lesion revascularization. Several clinical cases are also mentioned in the article.

The acute coronary syndromes (ACS), with or without ST-segment elevation, share a common pathophysiology of activated platelets and thrombin generation stimulated by plaque erosion and rupture. Both mechanical and pharmacologic treatment strategies have evolved in an attempt to improve reperfusion at the myocardial tissue level. Intracoronary stents have lowered the incidence of abrupt vessel closure and restenosis, while potent platelet inhibition from intravenous glycoprotein IIb/IIIa antagonists has reduced the rate of periprocedural myocardial infarction and late mortality. Abciximab has well-established clinical benefits in percutaneous revascularization trials, and several recent landmark studies have evaluated the efficacy of concomitant abciximab during mechanical reperfusion therapy in the setting of ACS. These trials are reviewed, and an overall perspective is provided. [Copyright &y& Elsevier]