The Relative Safety and Efficacy of Abciximab and Eptifibatide in Patients Undergoing Primary Percutaneous Coronary InterventionInsights 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.
View larger version (39K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Temporal Trends in Use of Abciximab Versus Eptifibatide in Patients Undergoing Primary PCI
There was no temporal trend in the relative use of abciximab versus eptifibatide. PCI = percutaneous coronary intervention.
|
|
View larger version (41K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Proportion of Patients Treated With Abciximab Versus Eptifibatide in a Given Hospital
Denominator reflects all patients undergoing primary percutaneous coronary intervention (PCI) at the hospital. There was wide variation in the relative use of abciximab versus eptifibatide across the participating hospitals. Although all hospitals use eptifibatide, abciximab use ranged from 0 to 56.7% of patients undergoing primary PCI.
|
|
View larger version (12K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Adjusted and Unadjusted In-Hospital Outcomes of Patients Treated With Abciximab Versus Eptifibatide
The first plot (left) shows unadjusted odds ratios, the second plot (center) shows risk-adjusted odds ratios, and the third plot (right) shows risk-adjusted and propensity-adjusted odds ratios. There was no difference in major cardiovascular complications between patients treated with abciximab and eptifibatide. Contrast nephropathy and gastrointestinal bleeding were more common in patients treated with abciximab, but this difference was not significant after risk adjustment or after adjusting for the propensity to receive abciximab. CABG = coronary artery bypass grafting; MACE = major adverse cardiac events.
|
|
View larger version (25K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 SMR in Patients Undergoing Primary PCI Based on Use of Eptifibatide and Abciximab
The observed mortality in patients treated with abciximab or eptifibatide was lower than the predicted mortality. The standardized mortality rates (SMR) (a ratio of observed mortality and predicted mortality) of patients treated with abciximab and eptifibatide were similar. PCI = percutaneous coronary intervention.
|
|
|
