Bailout use of platelet glycoprotein IIb-IIIa inhibition during coronary stent implantation: observations from the ESPRIT trial.
Glycoprotein (GP) IIb/IIIa inhibitors are often used as a rescue or bailout therapy to manage complications arising during percutaneous coronary intervention, rather than as prophylactic treatment. We sought to identify the characteristics and outcomes of patients requiring bailout treatment. The ESPRIT trial randomized 2,064 patients to receive eptifibatide or placebo starting immediately before percutaneous coronary intervention (PCI). Bailout therapy was used in 77 patients: 43 (4.2%) randomized to placebo and 34 (3.3%) to eptifibatide (p = 0.3). Bailout therapy for thrombosis was used more often in the placebo group (2.1% versus 1.0%; p = 0.03). Multivariable predictors of bailout included a greater than or equal to 90% stenosis, or visible thrombus on the baseline angiogram, and no aspirin pre-treatment before PCI. However, overall the model predicted bailout poorly (c-index = 0.64). The need for bailout cannot be reliably predicted using baseline characteristics. Patients experiencing complications have poor clinical outcomes despite bailout use of GP IIb/IIIa inhibitors.
Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8. cantorw@smh.toronto.on.ca
Warren J
WJ
Cantor
Mina
M
Madan
J Conor
JC
O'Shea
Robert J
RJ
Chisholm
Henry K
HK
Lui
David J
DJ
Cohen
Robert L
RL
Feldman
Robert
R
Green
Anne S
AS
Hellkamp
Michael M
MM
Kitt
James E
JE
Tcheng
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000628:therapy*; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D010919:Placebos; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D015607:Stents
D010455:Peptides; D010919:Placebos; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide