Key result
Eptifibatide maintenance dose infusion in patients undergoing primary percutaneous coronary intervention for STEMI did not significantly reduce 3-month major adverse cardiovascular events (28.6% vs 35.0%, p=0.286).
Why the study?
Few studies had investigated the effect of a maintenance dose of eptifibatide in patients with STEMI who underwent PPCI.
Does a maintenance dose of eptifibatide reduce 3-month MACE in STEMI patients undergoing primary percutaneous coronary intervention?
RCT (n=264)
Double-blind
Randomized
No
Does a maintenance dose of eptifibatide reduce 3-month MACE in STEMI patients undergoing primary percutaneous coronary intervention?
Absolute Event Rate: 28.6% vs 35%
p-value: p=0.286
A 12-hour maintenance infusion of eptifibatide after primary PCI for STEMI does not significantly reduce overall 3-month MACE, but it may safely reduce the rates of re-infarction and target lesion revascularization without increasing bleeding risk.
Does not support routine maintenance eptifibatide after STEMI primary PCI; leaves open questions on secondary ischemic endpoints.
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is usually caused by a rupture in the atherosclerotic plaque, followed by platelet aggregation which ultimately leads to acute coronary artery occlusion. So far, few studies have investigated the effect of maintenance dose of Eptifibatide (glycoprotein IIb/IIIa inhibitor) in STEMI patients who underwent primary percutaneous coronary intervention (PPCI). Therefore, in this study, we investigated the effect of maintenance dose of Eptifibatide in patients with STEMI who underwent PPCI. 264 patients who had acute chest pain suggestive of STEMI were entered in the study. All patients received the same dose of bolus dose of Eptifibatide in the cardiac catheterization laboratory. Then the patients were randomly divided into two groups, one group (n = 147) received a maintenance dose of intravenous Eptifibatide (infusion of 2 μg/kg/min) and the other group (n = 117) did not receive this treatment. Standard medical treatment of STEMI after PPCI was performed based on guidelines and the same in both groups. All patients were evaluated 1, 2, and 3 months after the start of treatment in terms of predicted outcomes. RESULTS: The occurrence of 3-month major adverse cardiovascular events (MACE) between the case and control groups did not have a statistically significant difference (28.6% versus 35.0%; P value: 0.286). Also, investigations showed that the rate of re-infarction (P value: 0.024) and target lesion revascularization (P value: 0.003) was significantly lower in the group that received Eptifibatide infusion. CONCLUSIONS: Eptifibatide maintenance dose infusion in patients who undergo PPCI in the context of STEMI, does not significantly reduce MACE, although it does significantly reduce re-infarction and target lesion revascularization. It also does not increase the risk of bleeding and cerebrovascular events.
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Jalalian et al. (2023) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=264). Eptifibatide vs. Standard medical treatment (no maintenance dose) was evaluated on 3-month major adverse cardiovascular events (MACE) (p=0.286). Eptifibatide maintenance dose infusion in patients undergoing primary percutaneous coronary intervention for STEMI did not significantly reduce 3-month major adverse cardiovascular events (28.6% vs 35.0%, p=0.286).
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