Author + information
- Nicola Ding1,
- Daniel A. Jones1,
- Mark Peterzan1,
- Sean Gallagher1,
- Sotiris Antoniou1,
- Paul Wright1,
- Krishnaraj Rathod1,
- Ajay Jain1,
- Charles Knight1,
- Anthony Mathur1,
- Roshan Weerackody1 and
- Andrew Wragg1
Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). There are few studies directly comparing these two agents. The aim of this study was to compare the effectiveness of eptifibatide relative to abciximab in patients with STEMI treated with PPCI.
This was an observational cohort study of 2083 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention (PPCI) from 2006 to 2012. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. The primary end-point was the first major adverse cardiac event (MACE) defined as death, non-fatal myocardial infarction, stroke or target vessel revascularisation.
1522 patients received abciximab and 561 received eptifibatide. Differences in baseline characteristics are outlined in Table 1. Patients receiving eptifibatide had higher rates of previous PCI and hypercholesterolaemia and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in 1-year event rates between patients given eptifibatide versus abciximab. Age-adjusted Cox analysis demonstrated no difference in 1 year outcome between abciximab and eptifibatide (HR 1.01 [95% CI 0.73-1.39]), which persisted after multivariate adjustment (HR 1.37 [95% CI 0.93-1.96]). Regression adjustment incorporating a propensity score (age, gender, ethnicity, previous MI, PCI or CABG, diabetes, hypertension, hypercholesterolaemia, smoking status, presence or absence of shock, and ejection fraction) into the hazards model as a covariate, showed no difference in outcome (HR 1.21 [95% CI 0.83-1.54]).
(n = 561)
(n = 1522)
|Gender (female)||139 (24.8%)||349(22.9%)||0.382|
|Previous PCI||72 (12.8%)||139 (9.4%)||0.028|
|Hypercholesterolaemia||298 (53.1%)||462 (42.4%)||<0.001|
|Access (radial)||339 (60.5%)||722(48.3%)||<0.001|
|Procedural Success||524 (93.4%)||1407(92.4%)||0.139|
This observational data suggests eptifibatide is associated with similar outcomes to abciximab in patients with STEMI undergoing PPCI.