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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

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

Insights From a Large Regional Registry of Contemporary Percutaneous Coronary Intervention

Hitinder S. Gurm, MD^_*,1, Dean E. Smith, MS, PhD^_*, J. Stewart Collins, MD^_*, David Share, MD, MPH, Arthur Riba, MD, Andrew J. Carter, MD, Thomas LaLonde, MD^||, Eva Kline-Rogers, RN, MS^_*, Michael O’Donnell, MD^¶, Hameem Changezi, MD^#, Marcel Zughaib, MD^_**, Robert Safian, MD, Mauro Moscucci, MD^_*,2,_* for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

^_* University of Michigan, Ann Arbor, Michigan
Blue Cross Blue Shield of Michigan, Detroit, Michigan
Oakwood Healthcare System, Dearborn, Michigan
Borgess Medical Center, Kalamazoo, Michigan
^|| St. Johns Hospital and Medical Center, Detroit, Michigan
^¶ St. Joseph Mercy Hospital, Ann Arbor, Michigan
^# Genesys Regional Medical Center, Grand Blanc, Michigan
^_** Providence Medical Center, Southfield, Michigan
William Beaumont Hospital, Royal Oak, Michigan.

Manuscript received June 19, 2007; revised manuscript received August 24, 2007, accepted September 23, 2007.

^_* Reprint requests and correspondence: Dr. Mauro Moscucci, University of Michigan Health System, University Hospital, TC B1-226, 1500 East Medical Center Drive, Ann Arbor, Michigan 48103-0311. (Email: Moscucci{at}umich.edu).

Objectives: This study sought to assess whether the use of eptifibatide instead of abciximab is associated with a difference in outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Background: Pooled data from randomized controlled trials suggest that the use of abciximab may be associated with a survival advantage in patients undergoing primary PCI for acute STEMI. However, a large proportion of patients in the community are treated with eptifibatide, an agent that shares some but not all pharmacological properties with abciximab.

Methods: We evaluated the outcomes of 3,541 patients who underwent primary PCI for STEMI from October 2002 to July 2006 in a large regional consortium and who were treated with abciximab (n = 729) or with eptifibatide (n = 2,812).

Results: There was no difference in the incidence of in-hospital death (4.1% with abciximab vs. 3.5% with eptifibatide, p = 0.39), recurrent myocardial infarction (0.8% vs. 1.2%, p = 0.42), or stroke/transient ischemic attack (0.7% vs. 0.6%, p = 0.80). There was no difference in the need for blood transfusion (12.4% vs. 11.7%, p = 0.61), whereas there was a greater incidence of gastrointestinal bleeding with abciximab (4.8% vs. 2.8%, p = 0.01). In parsimonious risk-adjusted models, no significant difference between abciximab and eptifibatide was observed with respect to any of the outcomes measures.

Conclusions: Currently, eptifibatide is used as the adjunct antiplatelet agent in the majority of patients undergoing primary PCI. There is no apparent difference in early outcomes of patients treated with eptifibatide compared with patients treated with abciximab.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   GP = glycoprotein   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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