March 22, 2011Journal of Interventional Cardiology16 citations
Integrilin in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
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Key Result
Adjunctive eptifibatide in patients undergoing primary PCI for STEMI was associated with lower 6-month all-cause mortality (HR 0.55; 95% CI 0.34-0.89; P=0.01).
Study Design
Type
Cohort (n=857)
Multicenter
No
Structured PICO
Does adjunctive eptifibatide reduce mortality and myocardial infarction in patients undergoing primary PCI for STEMI?
P
Population
857 consecutive patients undergoing primary PCI for STEMI, excluding those who received prior thrombolysis, followed for 6 months.
E
Exposure
Adjunctive therapy with eptifibatide (n=318)
C
Comparator
No adjunctive eptifibatide (n=539)
O
Outcome
All-cause mortality and the composite of all-cause mortality or Q-wave MI at 6 monthshard clinical
In an observational cohort of STEMI patients undergoing primary PCI, adjunctive eptifibatide was associated with reduced 6-month mortality and Q-wave MI without a significant increase in major bleeding.
Main Result
Hazard Ratio: 0.55 (95% CI 0.34–0.89)
p-value: p=0.01
Abstract
BACKGROUND: The adjunctive use of eptifibatide in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains controversial. We therefore set out to determine the safety and efficacy of eptifibatide in this population. METHODS: The study comprised 857 consecutive patients who underwent primary PCI for STEMI at the Washington Hospital Center. Three hundred eighteen patients also received adjunctive therapy with eptifibatide. Patients who had received thrombolysis prior to undergoing cardiac catheterization were excluded. The primary end-point was all-cause mortality and the composite of all-cause mortality or Q-wave MI. The primary safety end-point was the rate of thrombolysis in myocardial infarction (TIMI) major bleeding. RESULTS: The eptifibatide group was younger, had a higher body mass index, and a lower proportion of patients with systemic hypertension, diabetes mellitus, previous history of ischemic heart disease, coronary revascularization, and congestive heart failure. This cohort also used bivalirudin less often (23.3% vs. 72%; P < 0.001). Following multivariable analysis, the eptifibatide group had a significantly lower rate of all-cause mortality (hazard ratio 0.55; 95% confidence interval 0.34-0.89; P = 0.01) and the composite of all-cause mortality or Q-wave MI (hazard ratio 0.59; 95% confidence interval 0.37-0.95; P = 0.03) at 6 months. The rate of TIMI major bleeding was similar in both groups (hazard ratio 0.54; 95% confidence interval 0.25-1.17; P = 0.12). CONCLUSION: The adjunctive use of eptifibatide in patients presenting with STEMI may be associated with improved clinical outcomes. (J Interven Cardiol 2011;24:351-356).