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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Clinical Characteristics Predict Benefits From Eptifibatide Therapy During Coronary Stenting

Insights From the Enhanced Suppression of the Platelet IIb/IIIa Receptor With Integrilin Therapy (ESPRIT) Trial

Joseph A. Puma, DO, FACC^_*,_*, Lesan T. Banko, MD^_*, Karen S. Pieper, MS, Terrence J. Sacchi, MD, FACC^_*, J. Conor O’Shea, MD, Jean Pierre Dery, MD and James E. Tcheng, MD, FACC

^_* New York Methodist Hospital-Cornell Heart Center, Brooklyn New York
Duke Clinical Research Institute, Durham, North Carolina

Manuscript received April 8, 2005; revised manuscript received July 29, 2005, accepted August 12, 2005.

^_* Reprint requests and correspondence: Dr. Joseph A. Puma, New York Methodist Hospital-Cornell Heart Center, 506 6th Street, 2 Buckley Pavilion, Brooklyn, New York 11215. (Email: joepuma1{at}aol.com).

OBJECTIVES: In order to determine a differential benefit from treatment, we compared the long-term outcome of high-risk versus low-risk patients and evaluated survival free from death or myocardial infarction at one year.

BACKGROUND: Newer anticoagulant strategies during percutaneous coronary intervention have necessitated a reanalysis of the role of intravenous GP IIb/IIIa inhibitors. The Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy trial randomized 2,064 patients undergoing nonurgent coronary stent implantation to eptifibatide or placebo.

METHODS: High-risk characteristics were defined as age >75 years, diabetes, elevated cardiac markers, ST-segment elevation myocardial infarction within 7 days, or unstable angina within 48 h of randomization. Age <5 years, absence of diabetes, and any other reason for admission were considered low risk characterstics.

RESULTS: There were 1,018 patients in the high-risk group (50.8% eptifibatide, 49.2% placebo) and 1,045 patients in the low-risk group (50.0% eptifibatide, 50.0% placebo). Baseline demographics were similar in both groups except for more hypertension (63% vs. 55%, respectively), peripheral vascular disease (8.2% vs. 5.2%, respectively), prior stroke (5.5% vs. 3.2%, respectively), and female gender (33% vs. 22%, respectively) in the high-risk than the low-risk group. At one year, the composite end point of death or myocardial infarction occurred in 15.89% of placebo patients and 7.99% of eptifibatide patients in the high-risk group and 9.02% of the placebo and 8.11% of eptifibatide patients in the low-risk group.

CONCLUSIONS: Although eptifibatide treatment improved outcomes for all patients, preprocedural clinical characteristics can define a subgroup of patients who may derive greatest benefit from its use during coronary stent placement.

Abbreviations and Acronyms   CK-MB = creatine kinase-MB   ESPRIT = Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy trial   GP = glycoprotein   MI = myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction   Tn-T = troponin-T

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