A randomized, placebo-controlled trial of early eptifibatide for non-ST-segment elevation acute coronary syndromes.
BACKGROUND
The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear.


METHODS
In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo for 12 to 24 hours before crossover to open-label eptifibatide. Serial creatine-kinase MB (CK-MB) and quantitative cardiac troponin T levels were collected during the first 24 hours to assess the impact of early platelet glycoprotein IIb/IIIa blockade on infarct size as measured by cardiac markers.


RESULTS
Median peak CK-MB (10.3 vs 11.8 ng/mL; P =.71) and peak quantitative cardiac troponin T levels (0.2 vs 0.3 ng/mL; P =.95) were similar between treatment groups, respectively. Median calculated peak CK-MB values (41 vs 40 ng/mL; P =.72) and area under the CK-MB curve measurements (980 vs 764 microg/min/L; P =.68) from curve-fitting analyses that could be performed in 106 of 311 patients were also similar.


CONCLUSIONS
In this pilot trial, early administration of eptifibatide in the emergency department did not modulate serologic measurements of infarct size in patients with NSTE ACS.
Roe
Matthew T
MT
Duke Clinical Research Institute, Durham, NC 27715, USA. roe00001@mc.duke.edu
Christenson
Robert H
RH
Ohman
E Magnus
EM
Bahr
Raymond
R
Fesmire
Francis M
FM
Storrow
Alan
A
Mollod
Michael
M
Peacock
W Frank
WF
Rosenblatt
Jeffrey A
JA
Yang
Hongqiu
H
Fraulo
Elizabeth S
ES
Hoekstra
James W
JW
Gibler
W Brian
WB
D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D003328:Coronary Thrombosis / Q000188:drug therapy*; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D003404:Creatinine / Q000097:blood; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004562:Electrocardiography; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology / Q000517:prevention & control; D010455:Peptides / Q000627:therapeutic use*; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D013577:Syndrome; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D007527:Isoenzymes; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020107:Troponin T; D003404:Creatinine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D000077542:Eptifibatide