Elsevier

The American Journal of Cardiology

Volume 139, 15 January 2021, Pages 15-21
The American Journal of Cardiology

Efficacy and Safety of Abbreviated Eptifibatide Treatment in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2020.09.054Get rights and content

Highlights

  • Eptifibatide mediates potent antithrombotic effects when used in primary PCI.

  • Standard eptifibatide infusion for several hours increases bleeding complications.

  • A novel, short eptifibatide regimen retains ischemic protection during primary PCI.

  • Bleeding complications are greatly reduced by the abbreviated eptifibatide regimen.

  • Avoiding prolonged eptifibatide treatment may improve clinical outcomes.

The glycoprotein IIb/IIIa inhibitor eptifibatide, administered as bolus followed by infusion, is an adjunctive antithrombotic treatment during primary percutaneous coronary intervention (PCI) in selected patients with ST-segment elevation myocardial infarction (STEMI). Whether both bolus and infusion are necessary to improve outcomes is unknown. We hypothesized that primary PCI with eptifibatide bolus only is non-inferior to the conventional treatment (bolus and infusion) with regard to infarct size, while reducing bleeding complications. We analyzed 720 consecutive STEMI patients receiving eptifibatide bolus only or conventional treatment in an observational case-control study utilizing propensity score matching of clinical and intervention-specific confounders. Infarct size was estimated based on myocardial bound creatine kinase, creatine kinase (CK), and CK area under the curve values, with a prespecified non-inferiority margin of 20%. Major bleeding was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium classification. Eptifibatide bolus only was administered to 147 patients (20%), which were matched 1:1 to patients receiving conventional treatment. Based on peak myocardial bound creatine kinase, CK and CK area under the curve values, infarct size was −8.4% (95% CI [−31.2%, 14.4%]), −11.6% (95% CI [−33.5%, 10.3%]), and −13.9% (95% CI [−34.1%, 6.2%]) after eptifibatide bolus, respectively, reaching prespecified noninferiority compared with conventional treatment. Bolus treatment significantly reduced major bleeding complications (OR 0.48, 95% CI [0.30, 0.79]). In conclusion, eptifibatide given as abbreviated bolus only to selected STEMI patients who underwent primary PCI was noninferior regarding infarct size and resulted in less bleeding complications compared with conventional bolus and infusion treatment.

Section snippets

Methods

The cohort includes consecutive STEMI patients treated between December 1, 2009, and April 30, 2016, at the Triemli Hospital in Zürich, Switzerland, by a primary PCI strategy within 24 hours of symptom onset. Data were collected by the treating physicians, and checked for completeness, plausibility and consistency by a trained study nurse. Patients resuscitated from out of hospital cardiac arrest as well as patients who did not have Thrombolysis in Myocardial Infarction 3 coronary blood flow at

Results

Of 2,215 consecutive STEMI patients who underwent primary PCI, 147 and 516 patients receiving eptifibatide bolus only or conventional bolus and infusion treatment, respectively, were included in subsequent analyses (Figure 1). Before matching, patients receiving eptifibatide bolus only were older compared with conventionally treated patients (62.4 ± 11.7 vs 59.7 ± 11.6 years, p = 0.013), had worse glomerular filtration rate (97 ± 33 vs 105 ± 40 ml/min/m2, p = 0.027), were treated later in the

Discussion

The results of this matched case-control study suggest that eptifibatide treatment facilitating successful primary PCI of selected contemporary STEMI patients can be safely abbreviated to a bolus only regimen. This strategy was not inferior with regard to myocardial infarct size, and reduced the risk of postprocedural major bleeding complications by more than 50% when compared with the conventional eptifibatide bolus and infusion regimen.

Previous randomized trials have consistently shown that

Author Contributions

Florian Fischer: Investigation, Writing – Review & Editing. Samriddhi Buxy: Formal analysis, Validation, Writing – Review & Editing. David J. Kurz: Conceptualization, Writing – Review & Editing. Franz R. Eberli: Writing – Review & Editing, Funding acquisition. Oliver Senn: Writing – Review & Editing, Supervision. Rainer Zbinden: Conceptualization, Writing – Review & Editing. Ulrike Held: Formal analysis, Validation, Writing – Review & Editing, Supervision. Matthias R. Meyer: Conceptualization,

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

Acknowledgment

We thank Britta Bottignole for her excellent administrative assistance in data collection.

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  • This study was supported by an unrestricted research grant from Biosensors International Group. The research grant provider had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the article for publication.

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