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Long-term Efficacy of Platelet Glycoprotein IIb/IIIa Integrin Blockade With Eptifibatide in Coronary Stent Intervention
J. Conor O'Shea, MD;
Christopher E. Buller, MD;
Warren J. Cantor, MD;
A. Bleakley Chandler, MD;
Eric A. Cohen, MD;
David J. Cohen, MD;
Ian C. Gilchrist, MD;
Neal S. Kleiman, MD;
Marino Labinaz, MD;
Mina Madan, MD;
Gail E. Hafley, MS;
Robert M. Califf, MD;
Michael M. Kitt, MD;
John Strony, MD;
James E. Tcheng, MD;
for the ESPRIT Investigators
JAMA. 2002;287:618-621.
Context In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days.
Objective To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention.
Design and Setting The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada.
Participants A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation.
Intervention Patients were randomly assigned to receive placebo (n = 1024) or eptifibatide (two 180-µg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 µg/kg per minute; n = 1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine.
Main Outcome Measures Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment.
Results Complete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P = .001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P = .007).
Conclusions Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.
Author Affiliations: Duke Clinical Research Institute, Durham, NC (Drs O'Shea, Califf, and Tcheng, and Ms Hafley); Vancouver General Hospital, Vancouver, British Columbia (Dr Buller); St Michael's Hospital, Toronto, Ontario (Dr Cantor); University Hospital, Augusta, Ga (Dr Chandler); Sunnybrook & Women's College Health Science Centre, Toronto, Ontario (Drs E. Cohen and Madan); Beth Israel Deaconess Medical Center, Boston, Mass (Dr D. Cohen); Pennsylvania State University, Hershey (Dr Gilchrist); Baylor College of Medicine, Houston, Tex (Dr Kleiman); University of Ottawa Heart Institute, Ottawa, Ontario (Dr Labinaz); COR Therapeutics, Inc, South San Francisco, Calif (Dr Kitt); and Schering-Plough Research Institute, Kenilworth, NJ (Dr Strony).
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