title: Abbreviated infusion of eptifibatide after successful coronary intervention The BRIEF-PCI (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention) randomized trial.
abstract: OBJECTIVE
  The purpose of this study was to assess whether the early discontinuation of eptifibatide infusion in nonemergent percutaneous coronary intervention (PCI) is associated with a higher frequency of periprocedural ischemic myonecrosis.
  
  
  BACKGROUND
  The recommended regimen for eptifibatide is a double bolus followed by an infusion for 18 h. It is not known whether the infusion can be shortened if the PCI is uncomplicated.
  
  
  METHODS
  We enrolled 624 patients with stable angina, acute coronary syndrome, or recent ST-segment elevation myocardial infarction (>48 h) who underwent successful coronary stenting and received eptifibatide. Patients were randomly assigned to receive either an 18-h infusion or an abbreviated infusion of <2 h. The primary end point was the incidence of periprocedural myonecrosis defined as troponin-I elevation >0.26 microg/l. Secondary end points included death, myocardial infarction, urgent target vessel revascularization at 30 days, and in-hospital major bleeding using the REPLACE-2 (Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events) trial criteria.
  
  
  RESULTS
  The incidence of periprocedural myonecrosis was 30.1% in the <2-h group versus 28.3% in the 18-h group (mean difference: 1.8%; upper bound of 95% confidence interval: 7.8%; p < 0.012 for noninferiority). The 30-day incidence of myocardial infarction, death, and target vessel revascularization was similar in both groups (p = NS). Major bleeding was less frequent in the <2-h group (1.0% vs. 4.2%, p = 0.02).
  
  
  CONCLUSIONS
  After uncomplicated PCI, eptifibatide infusion can be abbreviated safely to <2 h. It is not inferior to the standard 18-h infusion in preventing ischemic outcome, and it may be associated with less major bleeding. (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention [BRIEF PCI]; NCT00111566).
authors.affiliation: Vancouver General Hospital, British Columbia, Canada. funga@interchange.ubc.ca
authors.forename: Anthony Y
authors.initials: AY
authors.lastname: Fung
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saw
authors.forename: Andrew
authors.initials: A
authors.lastname: Starovoytov
authors.forename: Cameron
authors.initials: C
authors.lastname: Densem
authors.forename: Percy
authors.initials: P
authors.lastname: Jokhi
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Walsh
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Fox
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
authors.forename: Eve
authors.initials: E
authors.lastname: Aymong
authors.forename: Donald R
authors.initials: DR
authors.lastname: Ricci
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Jaap N
authors.initials: JN
authors.lastname: Hamburger
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000628:therapy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D019233:Retreatment; D015607:Stents
chemical_list: D005343:Fibrinolytic Agents; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide; D001241:Aspirin