Why the study?
Does eptifibatide added to heparin, aspirin, and high-dose clopidogrel before catheterization improve clinical outcomes in patients with STEMI referred for primary PCI?
Does eptifibatide added to heparin, aspirin, and high-dose clopidogrel before catheterization improve clinical outcomes in patients with STEMI referred for primary PCI?
In STEMI patients pretreated with high-dose clopidogrel and referred for primary PCI, adding eptifibatide to heparin before catheterization did not improve clinical outcomes and increased bleeding complications.
No outcome benefit from adding eptifibatide before primary PCI; supports heparin monotherapy in high-dose clopidogrel-pretreated STEMI.
Background-Primary percutaneous coronary intervention, if performed promptly, is the preferred strategy to restore flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction.We sought to determine whether eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor, given before catheterization would improve clinical outcomes in patients referred for primary percutaneous coronary intervention.Methods and Results-We randomly assigned a total of 400 patients with ST-segment elevation myocardial infarction referred for primary percutaneous coronary intervention to treatment initiated before cardiac catheterization, with either heparin plus eptifibatide (201 patients) or heparin alone (199 patients), in addition to oral aspirin (160 mg) and high-dose clopidogrel (600 mg).The primary end point was a composite of death from any cause, recurrent myocardial infarction, or recurrent severe ischemia during the first 30 days after randomization.At 30 days, the primary end point was reached by 13 patients (6.47%) assigned to heparin plus eptifibatide and by 11 patients (5.53%) assigned to heparin alone (relative risk, 1.18; 95% CI, 0.52 to 2.70; Pϭ0.69).The rates of major or minor bleeding were higher in patients assigned to heparin plus eptifibatide than that in patients assigned to heparin alone (22.4% versus 14.6%; relative risk, 1.69; 95% CI, 1.01 to 2.83; Pϭ0.04).Conclusions-In patients pretreated with high-dose clopidogrel who were referred for primary PCI, treatment with heparin plus eptifibatide, when compared with heparin alone, did not improve clinical outcomes and was associated with more bleeding complications.(Circ Cardiovasc Intervent.2009;2:330-338.)Key Words: myocardial infarction Ⅲ primary percutaneous angioplasty Ⅲ platelets Ⅲ eptifibatide A ctivated platelets play a major role in the cascade of events leading to ST-segment elevation myocardial infarction (STEMI).2][3][4] This is particularly relevant for patients undergoing primary percutaneous coronary intervention (PCI), where antiplatelet therapy may prevent thrombotic reocclusion of the infarct-related artery.
No takes yet. Share an insight, caveat, or question.
May et al. (2009) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: