Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention.
BACKGROUND
In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days.


OBJECTIVE
To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention.


METHODS
The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada.


METHODS
A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation.


METHODS
Patients were randomly assigned to receive placebo (n = 1024) or eptifibatide (two 180-microg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 microg/kg per minute; n = 1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine.


METHODS
Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment.


RESULTS
Complete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P =.001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P =.007).


CONCLUSIONS
Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.
O'Shea
J Conor
JC
Duke Clinical Research Institute, PO Box 17969, Durham, NC 27705. oshea002@mc.duke.edu
Buller
Christopher E
CE
Cantor
Warren J
WJ
Chandler
A Bleakley
AB
Cohen
Eric A
EA
Cohen
David J
DJ
Gilchrist
Ian C
IC
Kleiman
Neal S
NS
Labinaz
Marino
M
Madan
Mina
M
Hafley
Gail E
GE
Califf
Robert M
RM
Kitt
Michael M
MM
Strony
John
J
Tcheng
James E
JE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004311:Double-Blind Method; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide