Journal Article

Efficacy and Safety of Abbreviated Eptifibatide Treatment in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Zbinden, Rainer, Fischer, Florian, Kurz, David J., Held, Ulrike, Buxy, Samriddhi, Senn, Oliver, Eberli, Franz R., Meyer, Matthias R.

2021

Overview

•Eptifibatide mediates potent antithrombotic effects when used in primary PCI.•Standard eptifibatide infusion for several hours increases bleeding complications.•A novel, short eptifibatide regimen retains ischemic protection during primary PCI.•Bleeding complications are greatly reduced by the abbreviated eptifibatide regimen.•Avoiding prolonged eptifibatide treatment may improve clinical outcomes. The glycoprotein IIb/IIIa inhibitor eptifibatide, administered as bolus followed by infusion, is an adjunctive antithrombotic treatment during primary percutaneous coronary intervention (PCI) in selected patients with ST-segment elevation myocardial infarction (STEMI). Whether both bolus and infusion are necessary to improve outcomes is unknown. We hypothesized that primary PCI with eptifibatide bolus only is non-inferior to the conventional treatment (bolus and infusion) with regard to infarct size, while reducing bleeding complications. We analyzed 720 consecutive STEMI patients receiving eptifibatide bolus only or conventional treatment in an observational case-control study utilizing propensity score matching of clinical and intervention-specific confounders. Infarct size was estimated based on myocardial bound creatine kinase, creatine kinase (CK), and CK area under the curve values, with a prespecified non-inferiority margin of 20%. Major bleeding was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium classification. Eptifibatide bolus only was administered to 147 patients (20%), which were matched 1:1 to patients receiving conventional treatment. Based on peak myocardial bound creatine kinase, CK and CK area under the curve values, infarct size was −8.4% (95% CI [−31.2%, 14.4%]), −11.6% (95% CI [−33.5%, 10.3%]), and −13.9% (95% CI [−34.1%, 6.2%]) after eptifibatide bolus, respectively, reaching prespecified noninferiority compared with conventional treatment. Bolus treatment significantly reduced major bleeding complications (OR 0.48, 95% CI [0.30, 0.79]). In conclusion, eptifibatide given as abbreviated bolus only to selected STEMI patients who underwent primary PCI was noninferior regarding infarct size and resulted in less bleeding complications compared with conventional bolus and infusion treatment.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Angioplasty / Anticoagulants / Bailouts / Bleeding / Blood clots / Consortia / Coronary Angiography / Coronary vessels / Creatine / Creatine kinase / Dose-Response Relationship, Drug / Electrocardiography / Embolization / Eptifibatide - administration & dosage / Female / Follow-Up Studies / Glycoproteins / Heart attacks / Humans / Injections, Intravenous / Kinases / Male / Middle Aged / Myocardial infarction / Patients / Percutaneous Coronary Intervention / Platelet Aggregation Inhibitors - administration & dosage / Preoperative Care - methods / Regression analysis / Retrospective Studies / Segments / ST Elevation Myocardial Infarction - diagnosis / ST Elevation Myocardial Infarction - therapy / Stents / Treatment Outcome / Veins & arteries