title: Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention.
abstract: 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.
authors.affiliation: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27705. oshea002@mc.duke.edu
authors.forename: J Conor
authors.initials: JC
authors.lastname: O'Shea
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: A Bleakley
authors.initials: AB
authors.lastname: Chandler
authors.forename: Eric A
authors.initials: EA
authors.lastname: Cohen
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Ian C
authors.initials: IC
authors.lastname: Gilchrist
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
authors.forename: Mina
authors.initials: M
authors.lastname: Madan
authors.forename: Gail E
authors.initials: GE
authors.lastname: Hafley
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kitt
authors.forename: John
authors.initials: J
authors.lastname: Strony
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
mesh_terms: 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
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide