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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Abbreviated Infusion of Eptifibatide After Successful Coronary Intervention

The BRIEF-PCI (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention) Randomized Trial

Anthony Y. Fung, MB, BS, FACC^_*,_*, Jacqueline Saw, MD^_*, Andrew Starovoytov, MD^_*, Cameron Densem, MD^_*, Percy Jokhi, MB, BChir, PhD^_*, Simon J. Walsh, MD^_*, Rebecca S. Fox, PA, MSc^_*, Karin H. Humphries, MSc, MBA, DSc, Eve Aymong, MD, MSc, Donald R. Ricci, MD, FACC^_*, John G. Webb, MD, FACC, Jaap N. Hamburger, MD, PhD^_*, Ronald G. Carere, MD, FACC and Christopher E. Buller, MD, FACC^_*

^_* Vancouver General Hospital, Vancouver, British Columbia, Canada
St. Paul's Hospital, Vancouver, British Columbia, Canada

Manuscript received April 15, 2008; revised manuscript received September 4, 2008, accepted September 8, 2008.

^_* Reprint requests and correspondence: Dr. Anthony Y. Fung, Cardiac Catheterization Laboratories, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, British Columbia V5Z 1M9, Canada (Email: funga{at}interchange.ubc.ca).

Objectives: The purpose of this study was to assess whether the early discontinuation of eptifibatide infusion in nonemergent percutaneous coronary intervention (PCI) is associated with a higher frequency of periprocedural ischemic myonecrosis.

Background: The recommended regimen for eptifibatide is a double bolus followed by an infusion for 18 h. It is not known whether the infusion can be shortened if the PCI is uncomplicated.

Methods: We enrolled 624 patients with stable angina, acute coronary syndrome, or recent ST-segment elevation myocardial infarction (>48 h) who underwent successful coronary stenting and received eptifibatide. Patients were randomly assigned to receive either an 18-h infusion or an abbreviated infusion of <2 h. The primary end point was the incidence of periprocedural myonecrosis defined as troponin-I elevation >0.26 µg/l. Secondary end points included death, myocardial infarction, urgent target vessel revascularization at 30 days, and in-hospital major bleeding using the REPLACE-2 (Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events) trial criteria.

Results: The incidence of periprocedural myonecrosis was 30.1% in the <2-h group versus 28.3% in the 18-h group (mean difference: 1.8%; upper bound of 95% confidence interval: 7.8%; p < 0.012 for noninferiority). The 30-day incidence of myocardial infarction, death, and target vessel revascularization was similar in both groups (p = NS). Major bleeding was less frequent in the <2-h group (1.0% vs. 4.2%, p = 0.02).

Conclusions: After uncomplicated PCI, eptifibatide infusion can be abbreviated safely to <2 h. It is not inferior to the standard 18-h infusion in preventing ischemic outcome, and it may be associated with less major bleeding. (Brief Infusion of Eptifibatide Following Percutaneous Coronary Intervention [BRIEF PCI]; NCT00111566 [ClinicalTrials.gov] )

Key Words: eptifibatide • glycoprotein IIb/IIIa inhibitors • platelet • stenting

Abbreviations and Acronyms   ACS = acute coronary syndrome   CK-MB = creatine kinase-myocardial band   GP = glycoprotein   MI = myocardial infarction   NHLBI = National Heart, Lung, and Blood Institute   PCI = percutaneous coronary intervention

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