PCI with and without abciximab after upstream eptifibatide use: outcomes in high-risk patients.
BACKGROUND
Abciximab is often used to treat high-risk patients during percutaneous coronary intervention (PCI). Recent data indicate, however, that upstream and postprocedural treatment with low-dose glycoprotein (GP) IIb/IIIa inhibitors may be more beneficial than abciximab during and after PCI. Whether abciximab can be used safely or effectively during PCI for high-risk patients after upstream treatment with eptifibatide in patients with acute coronary syndromes (ACS) is not known.


METHODS
Clinical outcomes were evaluated in 289 patients with ACS who had upstream treatment with eptifibatide, and abciximab (EA) during PCI, and compared to 560 ACS patients who had both upstream and interventional treatment with eptifibatide (EE).


RESULTS
Bleeding and vascular complications of the two groups were similar. Overall, 1-year major adverse cardiac event (MACE) rates were similar: 26.0% in the EA group and 25.2% in the EE group; p = 0.82. In patients with unstable angina, the hazard of MACE at 1 year was higher with EA than EE, 1.98 (1.23-3.18), due to significantly higher rates of repeat revascularization in the EA group. In patients with myocardial infarction (MI), the hazard of MI or death at 1 year was lower in the EA than the EE group, 0.50 (0.27-0.93).


CONCLUSIONS
In this single-center observational study, the use of abciximab for PCI after upstream use of eptifibatide for ACS was safe. Abciximab was of no benefit in patients with unstable angina, but was associated with lower MI or death in patients with MI. These observations are consistent with recent findings indicating that abciximab is of benefit in patients with NSTEMI, but not lower-risk patients.
Applegate
Robert J
RJ
Wake Forest University School of Medicine, Section of Cardiology, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA. bapplega@wfubmc.edu
Grabarczyk
Mark A
MA
Sane
David C
DC
Sacrinty
Matthew T
MT
Goodin
Jason E
JE
Statonk
G Sidney
GS
Baki
Talal T
TT
Gandhi
Sanjay K
SK
Kutcher
Michael A
MA
Little
William C
WC
D000077284:Abciximab; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy* / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide; D000077284:Abciximab