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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Eptifibatide Is Noninferior to Abciximab in Primary Percutaneous Coronary Intervention

Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)

Axel Åkerblom, MD^_*,_*, Stefan K. James, MD, PhD^_*, Michail Koutouzis, MD, PhD, Bo Lagerqvist, MD, PhD^_*, Ulf Stenestrand, MD, PhD, Bodil Svennblad, PhD and Jonas Oldgren, MD, PhD^_*

^_* Department of Cardiology, Uppsala University, Uppsala, Sweden
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden

Manuscript received September 18, 2009; revised manuscript received October 16, 2009, accepted October 26, 2009.

^_* Reprint requests and correspondence: Dr. Axel Åkerblom, Uppsala Clinical Research Center, Uppsala University, UCR/MTC, 751 85 Uppsala, Sweden (Email: axel.akerblom{at}ucr.uu.se).

Objectives: The aim of this study was to test the noninferiority of eptifibatide relative to abciximab in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Background: Glycoprotein IIb/IIIa inhibitors are recommended by international guidelines in patients with acute coronary syndromes undergoing PCI. Abciximab is recommended with a higher level of evidence than eptifibatide in patients with STEMI. No large, prospective, randomized trial comparing abciximab and eptifibatide has been published.

Methods: All (n = 11,479) STEMI patients in Sweden who underwent primary PCI and received either eptifibatide or abciximab from 2004 to 2007 were derived from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The primary end point was death or myocardial infarction (MI) during 1-year follow-up, with adjustment for baseline differences with a multivariate logistic regression analysis including propensity score. The pre-specified noninferiority margin was set to 1.29.

Results: The combined end point occurred in 353 of 2,355 patients (15.0%) treated with eptifibatide and in 1,432 of 9,124 patients (15.7%) treated with abciximab. The unadjusted odds ratio (OR) for eptifibatide versus abciximab was 0.95 (95% confidence interval [CI]: 0.84 to 1.08). Multivariate adjustment (n = 11,317) confirmed noninferiority, with an OR of 0.94 (95% CI: 0.82 to 1.09). The adjusted secondary end points of death and MI separately also showed noninferiority, with ORs of 0.99 (95% CI: 0.82 to 1.19) and 0.88 (95% CI: 0.73 to 1.05), respectively.

Conclusions: This large registry study suggests that eptifibatide is noninferior to abciximab in patients with STEMI undergoing primary PCI with respect to death or MI during 1 year, thereby supporting the use of either drug in clinical practice.

Key Words: eptifibatide • abciximab • ST-segment elevation myocardial infarction • death • myocardial infarction

Abbreviations and Acronyms   ACS = acute coronary syndromes   CI = confidence interval   GP = glycoprotein   MI = myocardial infarction   OR = odds ratio   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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