Early versus Delayed, Provisional Eptifibatide in Acute Coronary Syndromes
Key result
Early eptifibatide ≥12 hours before angiography was not superior to provisional use after angiography for death, MI, recurrent ischemia, or thrombotic bailout (OR 0.92; 95% CI 0.80-1.06; P=0.23).
Why the study?
Does early routine administration of eptifibatide reduce ischemic complications compared to delayed provisional administration in patients with NSTE-ACS undergoing an invasive strategy?
Population
9,492 patients with acute coronary syndromes without ST-segment elevation who were assigned to an invasive…
Comparison
Early eptifibatide vs Matching placebo infusion with provisional use…
Design
RCT, Randomly assigned, Matching placebo
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Avoid routine early eptifibatide in NSTE-ACS; confirms provisional use to limit bleeding without ischemic benefit.
Study Design
Type
RCT (n=9,492)
Blinding
Placebo-controlled
Randomization
Randomly assigned
Structured PICO
Does early routine administration of eptifibatide reduce ischemic complications compared to delayed provisional administration in patients with NSTE-ACS undergoing an invasive strategy?
P
Population
9,492 patients with acute coronary syndromes without ST-segment elevation who were assigned to an invasive strategy
I
Intervention
Early eptifibatide (two boluses, each containing 180 microg per kilogram of body weight, administered 10 minutes apart, and a standard infusion ≥ 12 hours before angiography)
C
Comparator
Matching placebo infusion with provisional use of eptifibatide after angiography (delayed eptifibatide)
O
Outcome
Composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or the occurrence of a thrombotic complication during percutaneous coronary intervention that required bolus therapy opposite to the initial study-group assignment ('thrombotic bailout') at 96 hourscomposite
Main Result
Effect estimate: OR 0.92 (95% CI 0.80 to 1.06)
Absolute Event Rate: 9.3% vs 10%
p-value: p=0.23
Routine early administration of eptifibatide before angiography in NSTE-ACS does not improve ischemic outcomes but increases bleeding compared to provisional use during PCI.
Cite This Study
Giugliano et al. (2009) conducted an RCT in Acute coronary syndromes without ST-segment elevation (n=9,492). Early eptifibatide vs. Matching placebo infusion with provisional use of eptifibatide after angiography was evaluated on Composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or thrombotic bailout at 96 hours (OR 0.92, 95% CI 0.80 to 1.06, p=0.23). Early eptifibatide ≥12 hours before angiography was not superior to provisional use after angiography for death, MI, recurrent ischemia, or thrombotic bailout (OR 0.92; 95% CI 0.80-1.06; P=0.23).