Background Aggregation of platelets is the pathophysiologicbasis of the acute coronary syndromes. Eptifibatide, a syntheticcyclic heptapeptide, is a selective high-affinity inhibitorof the platelet glycoprotein IIb/IIIa receptor, which is involvedin platelet aggregation. We tested the hypothesis that inhibitionof platelet aggregation with eptifibatide would have an incrementalbenefit beyond that of heparin and aspirin in reducing the frequencyof adverse outcomes in patients with acute coronary syndromeswho did not have persistent ST-segment elevation.
Methods Patients who had presented with ischemic chest painwithin the previous 24 hours and who had either electrocardiographicchanges indicative of ischemia (but not persistent ST-segmentelevation) or high serum concentrations of creatine kinase MBisoenzymes were enrolled in the study. They were randomly assigned,in a double-blind manner, to receive a bolus and infusion ofeither eptifibatide or placebo, in addition to standard therapy,for up to 72 hours (or up to 96 hours, if coronary interventionwas performed near the end of the 72-hour period). The primaryend point was a composite of death and nonfatal myocardial infarctionoccurring up to 30 days after the index event.
Results A total of 10,948 patients were enrolled between November1995 and January 1997. As compared with the placebo group, theeptifibatide group had a 1.5 percent absolute reduction in theincidence of the primary end point (14.2 percent, vs. 15.7 percentin the placebo group; P=0.04). The benefit was apparent by 96hours and persisted through 30 days. The effect was consistentin most major subgroups except for women (odds ratios for deathor nonfatal myocardial infarction, 0.8 [95 percent confidenceinterval, 0.7 to 0.9] in men, and 1.1 [0.9 to 1.3] in women).Bleeding was more common in the eptifibatide group, althoughthere was no increase in the incidence of hemorrhagic stroke.
Conclusions Inhibition of platelet aggregation with eptifibatidereduced the incidence of the composite end point of death ornonfatal myocardial infarction in patients with acute coronarysyndromes who did not have persistent ST-segment elevation.
Source Information
On behalf of the Steering Committee, Robert A. Harrington, M.D., assumes responsibility for the overall content of the manuscript.
Address reprint requests to Dr. Harrington at the Duke Clinical Research Institute, 2024 W. Main St., Durham, NC 27705.
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