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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Effect of glycoprotein IIb/IIIa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial

James C. Blankenship, MD, FACC^*, Gudaye Tasissa, PhD, J. Conor O’Shea, MD, Elias A. Iliadis, MD^*, Fouad A. Bachour, MD, FACC^*, David J. Cohen, MD, MSc, Henry K. Lui, MD, FACC, Tift Mann, III, MD, FACC^||, Eric Cohen, MD^¶, James E. Tcheng, MD, FACC for the ESPRIT Investigators

^* Geisinger Medical Center, Danville, Pennsylvania, USA
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
Beth Israel Hospital, Boston, Massachusetts, USA
Jackson Madison General, Jackson, Tennessee, USA
^|| Wake Heart Associates, Raleigh, North Carolina, USA
^¶ Sunnybrook Hospital, Toronto, Ontario, Canada

Manuscript received January 16, 2001; revised manuscript received April 27, 2001, accepted May 17, 2001.

Reprint requests and correspondence: Dr. James Blankenship, Department of Cardiology, Geisinger Medical Center, 21-60, Danville, Pennsylvania 17822
jblankenship{at}geisinger.edu

OBJECTIVES

We sought to determine whether eptifibatide decreases the incidence of in-laboratory angiographic complications and to determine the relationship of angiographically evident complications to elevations of creatine kinase-MB (CK-MB) enzyme levels during percutaneous coronary intervention.

BACKGROUND

In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, eptifibatide during coronary intervention was associated with decreased ischemic complications at 48 h and 30 days.

METHODS

Patients (n = 2,064) were randomized to placebo versus eptifibatide (two 180 µg/kg boluses 10 min apart and as a continuous infusion of 2 µg/kg per min) during percutaneous coronary stenting. Angiographic complications including major dissection, distal embolization, residual thrombus, abrupt closure, residual stenosis >50% and side-branch occlusion were prospectively recorded by the operator. Creatine kinase-MB levels were measured after the procedure and every 6 h thereafter. The incidence of angiographic complications and CK-MB elevation was determined for eptifibatide versus placebo groups.

RESULTS

Eptifibatide-treated patients demonstrated nonsignificant trends toward fewer angiographic complications (10 vs. 12% for placebo patients, p = 0.13) and, for patients with angiographic complications, fewer subsequent CK-MB elevations (43 vs. 50% for placebo patients, p = 0.31). In patients without any angiographic complications, the incidence of CK-MB elevation >3 times the normal was 7% with placebo and 4% with eptifibatide (p = 0.003).

CONCLUSIONS

Eptifibatide during nonurgent coronary stent intervention only minimally (and insignificantly) reduces the incidence of angiographic complications and subsequent CK-MB elevations in patients developing an angiographic complication. The greater effect is to reduce myocardial infarction in patients undergoing otherwise uneventful coronary stent implantation as well as in the overall study population.

Abbreviations and Acronyms   CK-MB = creatine kinase-MB   ESPRIT = Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy trial   GP = glycoprotein   IMPACT = Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis trial   MI = myocardial infarction

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