The Relative Safety and Efficacy of Abciximab and Eptifibatide in Patients Undergoing Primary Percutaneous Coronary Intervention

Gurm, Hitinder S.; Smith, Dean E.; Collins, John; Share, David; Riba, Arthur; Carter, Andrew J.; LaLonde, Thomas; Kline–Rogers, Eva; O’Donnell, Michael J.; Changezi, Hameem; Zughaib, Marcel; Safian, Robert D.; Moscucci, Mauro

doi:10.1016/j.jacc.2007.09.053

Cited by 88 publications

(38 citation statements)

References 17 publications

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“…Studies comparing smallmolecule GP IIb/IIIa receptor inhibitors with abciximab without randomization were excluded. 2,7,8 One randomized trial was excluded, because it did not provide angiographic or mortality data. 14 Our meta-analysis, thus, included 5 trials that randomized patients with STEMI to small-molecule GP IIb/IIIa receptor inhibitors versus abciximab.…”

Section: Resultsmentioning

confidence: 99%

“…Although the current guidelines support the use of abciximab in patients undergoing primary PCI, a number of patients are treated with smallmolecule glycoprotein (GP) IIb/IIIa agents or without GP IIbIIIa inhibitors in "real-world" clinical practice for various reasons. 2,3 The absolute magnitude of survival benefit demonstrated in association with abciximab is small and somewhat controversial. 4 -6 Further, eptifibatide or tirofibansmall-molecule agents that share some but not all pharmacological properties with abciximab-are significantly less expensive and more widely available in many hospitals.…”

mentioning

confidence: 99%

“…Observational data suggest similar outcomes in patients undergoing primary PCI who are treated with smallmolecule GP IIb/IIIa inhibitors compared with those treated with abciximab. 2,7,8 …”

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confidence: 99%

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A Comparison of Abciximab and Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Primary Percutaneous Coronary Intervention

Gurm

Tamhane

Meier

et al. 2009

Circ: Cardiovascular Interventions

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Background-Current guidelines recommend abciximab as the preferred agent for patients undergoing primary percutaneous coronary intervention, yet small-molecule glycoprotein IIb/IIIa inhibitors are more commonly used in clinical practice. The objective of our meta-analysis was to evaluate for differences in clinical outcome between small-molecule glycoprotein IIb/IIIa inhibitors and abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-Five randomized trials (nϭ2138 patients) comparing tirofiban or eptifibatide with abciximab as an adjunctive therapy to primary percutaneous coronary intervention were included in this meta-analysis. Summary odds ratios (ORs) for 30-day death, reinfarction, and major bleeding were calculated using random-and fixed-effect models. There were no differences in 30-day mortality (

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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A Comparison of Abciximab and Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Primary Percutaneous Coronary Intervention

Gurm

Tamhane

Meier

et al. 2009

Circ: Cardiovascular Interventions

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“…The details of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry and its data collection and auditing process have been described previously. [11][12][13][14] Briefly, procedural data on all patients undergoing PCI at participating hospitals are collected using standardized data collection forms. Baseline data include clinical, demographic, procedural, and angiographic characteristics, as well as medications used before, during, and after the procedure, and in-hospital outcomes.…”

Section: Gurm Et Al Cath Laboratory-only Eptifibatide For Pcimentioning

confidence: 99%

Comparative Effectiveness and Safety of a Catheterization Laboratory–Only Eptifibatide Dosing Strategy in Patients Undergoing Percutaneous Coronary Intervention

Gurm

Hosman

et al. 2015

Circ: Cardiovascular Interventions

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Background-Eptifibatide, a small-molecule glycoprotein IIb/IIIa inhibitor, is conventionally administered as a bolus plus infusion. A growing number of clinicians are using a strategy of catheterization laboratory-only eptifibatide (an off-label use) as procedural pharmacotherapy for patients undergoing percutaneous coronary intervention although the comparative effectiveness of this approach is unknown. Methods and Results-We compared the in-hospital outcome of patients undergoing percutaneous coronary intervention across 47 hospitals and treated with eptifibatide bolus plus infusion with those treated with a catheterization laboratoryonly regimen. We used optimal matching to link the use of catheterization laboratory-only eptifibatide with clinical outcomes, including mortality, myocardial infarction, bleeding, and need for transfusion. Of the 84 678 percutaneous coronary interventions performed during 2010 to 2011, and meeting our inclusion criteria, eptifibatide was administered to 21 296 patients. Of these, a catheterization laboratory-only regimen was used in 4511 patients, whereas 16 785 patients were treated with bolus plus infusion. In the optimally matched analysis, compared with bolus plus infusion, a catheterization laboratory-only regimen was associated with a reduction in bleeding (optimally matched adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.93; P=0.014) and need for transfusion (optimally matched adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.92; P=0.012), with no difference in mortality or myocardial infarction. Conclusions-A catheterization laboratory-only eptifibatide regimen is commonly used in clinical practice and is associated with a significant reduction in bleeding complications in patients undergoing contemporary percutaneous coronary intervention. (Circ Cardiovasc Interv. 2015;8:e001880.

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“…All patients will receive aspirin 300 mg, clopidogrel 600 mg and heparin 70 IU/kg (maximum 7,000 IU) before or during procedure and the glycoprotein IIb/IIIa inhibitor eptifibatide during angioplasty, using a standard regimen of weight-adjusted bolus followed by infusion for minimum 12 h [23]. The patients will be treated according to the current guidelines for management of STEMI patients as stated by the European Society of Cardiology [2].…”

Section: The Postemi Studymentioning

confidence: 99%

Rationale and Design of the POSTEMI (Postconditioning in ST-Elevation Myocardial Infarction) Study

Limalanathan¹,

Andersen²,

Hoffmann

et al. 2010

Cardiology

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Rapid reperfusion of the infarct-related coronary artery is essential in the treatment of acute ST-elevation myocardial infarction (STEMI). Paradoxically, restoration of the blood flow to the ischemic area may result in further injury to the myocardium. This phenomenon is described as ‘ischemia/reperfusion injury’ and the pathophysiological mechanisms are not fully elucidated. A cardioprotective effect of ischemic postconditioning (short repetitive cycles of reperfusion and re-occlusion) has been demonstrated in experimental studies and in pilot studies on patients with acute STEMI treated with primary percutaneous coronary intervention. We present the study design of the Postconditioning in ST-Elevation Myocardial Infarction (POSTEMI) study, which is a prospective, randomized, open-label clinical trial with blinded endpoint evaluation designed to evaluate the effect of postconditioning on final infarct size. Patients with acute STEMI with symptoms of less than 6 h and proximal or mid-coronary artery occlusion will be included. The primary endpoint is infarct size, assessed by cardiac MRI after 4 months. The secondary endpoints are to evaluate the effect of postconditioning on TIMI myocardial perfusion grade, resolution of ST-segment elevation, release of markers of ischemia, left ventricular function and final infarct size related to the area at risk. A total of 260 patients will be included in the study.

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The Relative Safety and Efficacy of Abciximab and Eptifibatide in Patients Undergoing Primary Percutaneous Coronary Intervention

Cited by 88 publications

References 17 publications

A Comparison of Abciximab and Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Primary Percutaneous Coronary Intervention

A Comparison of Abciximab and Small-Molecule Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Primary Percutaneous Coronary Intervention

Comparative Effectiveness and Safety of a Catheterization Laboratory–Only Eptifibatide Dosing Strategy in Patients Undergoing Percutaneous Coronary Intervention

Rationale and Design of the POSTEMI (Postconditioning in ST-Elevation Myocardial Infarction) Study

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