Duration of eptifibatide infusion after percutaneous coronary intervention and outcomes among high-risk patients with non-ST-segment elevation acute coronary syndrome: insights from EARLY ACS.

TitleDuration of eptifibatide infusion after percutaneous coronary intervention and outcomes among high-risk patients with non-ST-segment elevation acute coronary syndrome: insights from EARLY ACS.
Publication TypeJournal Article
Year of Publication2013
AuthorsHess, Connie N., Phillip J. Schulte, Kristin L Newby, Philippe Gabriel Steg, Anthony J. Dalby, Marc J. Schweiger, Basil S. Lewis, Paul W. Armstrong, Robert M. Califf, Frans van de Werf, and Robert A. Harrington
JournalEur Heart J Acute Cardiovasc Care
Volume2
Issue3
Pagination246-55
Date Published2013 Sep
ISSN2048-8734
KeywordsAcute Coronary Syndrome, Eptifibatide, Female, Hemorrhage, Humans, Infusions, Intravenous, Male, Middle Aged, Myocardial Infarction, Myocardial Ischemia, Peptides, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Recurrence, Risk Factors, Treatment Outcome
Abstract

BACKGROUND AND OBJECTIVES: Eptifibatide is indicated during percutaneous coronary intervention (PCI) with continuation for 18-24 hours post procedure but is associated with bleeding. We examined the efficacy and safety of shorter post-PCI eptifibatide infusions in high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients.METHODS: EARLY ACS patients treated with PCI and eptifibatide were grouped by post-procedure infusion duration: <10, 10-13, 13-17, and 17-25 (per protocol) hours. Adjusted estimated event rates for 96-hour death/myocardial infarction (MI)/recurrent ischaemia requiring urgent revascularization (RIUR), 30-day death/MI, post-PCI packed red blood cell (PRBC) transfusion, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate/severe bleeding were obtained using inverse-propensity weighting to account for informative censoring of infusions.RESULTS: Among 3271 eptifibatide-treated PCI patients, there were 66 96-hour death/MI/RIUR events, 94 30-day death/MI events, 127 PRBC transfusions, and 115 GUSTO moderate/severe bleeds. Compared with per protocol, patients receiving post-PCI infusions <10 hours had similar adjusted estimated rates of 96-hour death/MI/RIUR (absolute difference 0.021 higher; 0.040 vs. 0.019, 95% CI -0.023 to 0.064; p=0.35) and 30-day death/MI (0.020 higher; 0.046 vs. 0.026, 95% CI -0.021 to 0.062; p=0.34). There were also no differences in ischaemic outcomes between infusions of 10-17 hours and per-protocol infusions. Adjusted estimated rates of PRBC transfusion were higher for the <10-hour infusion group compared with per protocol (0.048 higher; 0.079 vs. 0.031, 95% CI 0.005 to 0.091, p=0.03) but were similar for other groups. Adjusted GUSTO moderate/severe bleeding rates were similar to per-protocol rates for all groups.CONCLUSIONS: In high-risk NSTE ACS patients, post-PCI eptifibatide infusions <18 hours were not associated with worse ischaemic outcomes. Shorter eptifibatide infusions in this population may be feasible.

DOI10.1177/2048872612474922
Alternate JournalEur Heart J Acute Cardiovasc Care
Original PublicationDuration of eptifibatide infusion after percutaneous coronary intervention and outcomes among high-risk patients with non-ST-segment elevation acute coronary syndrome: insights from EARLY ACS.
PubMed ID24222836
PubMed Central IDPMC3821813
Grant ListT32 HL079896 / HL / NHLBI NIH HHS / United States
T32 HL069749 / HL / NHLBI NIH HHS / United States
P01CA142538 / CA / NCI NIH HHS / United States
P01 CA142538 / CA / NCI NIH HHS / United States
5T32HL069749-09 / HL / NHLBI NIH HHS / United States
Project: