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In patients with ST-segment elevation myocardial infarction (STEMI), the glycoprotein IIb/IIIa inhibitors (GPIs) abciximab and eptifibatide yield comparable bleeding risks and clinical efficacy during primary percutaneous coronary intervention (PCI), according to a subanalysis of the HORIZONS-AMI trial published online July 2, 2012, ahead of print in the American Journal of Cardiology.

In the multicenter HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 STEMI patients undergoing primary PCI were first randomized to anticoagulation with bivalirudin monotherapy or unfractionated heparin plus a GPI. After angiography, 3,006 patients with lesions eligible for stenting were randomized 3:1 to a paclitaxel-eluting stent (PES, Taxus Express2) or a BMS (Express2; both Boston Scientific, Natick, MA).

For the post-hoc analysis, researchers led by George D. Dangas, MD, PhD, of Mount Sinai Medical Center (New York, NY), compared clinical outcomes of the 1,710 patients in the heparin plus GPI arm who were treated with either abciximab (0.25 mg/kg bolus followed by a 12-hour infusion at 0.125 g/kg/min; n = 907) or eptifibatide (2 boluses at 180 g/kg administered 10 minutes apart and followed by an infusion at 2.0 g/kg/min for 12 to 18 hours; n = 803).

Equivalent Efficacy, Outcomes

Immediate procedural revascularization success was high in both groups, with TIMI grade 3 flow in the culprit vessel achieved in 92% of the abciximab group and 91% of the eptifibatide group (P = 0.60). The 2 treatment arms achieved similar rates of complete ST-segment resolution at 60 minutes (51.3% with abciximab, 48.7% with eptifibatide; P = 0.34). Rates of postprocedural thrombocytopenia (platelet count < 100,000 cells/mm³), though, were 5.3% with abciximab and 2.1% with eptifibatide (P = 0.0008).

At 3 years, there were no differences in MACE, major bleeding, and net adverse clinical events between groups, although there was a slight benefit in target vessel revascularization with abciximab (table 1).

Table 1. Unadjusted 3-Year Outcomes

Abbreviation: NACE, net adverse clinical events (any MACE or major bleeding event excluding those related to CABG).

Likewise, there were no differences in patient outcomes between the GPI groups when stratified by clopidogrel loading dose. After multivariate analysis, these similarities remained.

Propensity score matching identified 1,342 matched cases (671 in each treatment arm), which also had comparable outcomes (table 2).

Table 2. Propensity-Matched 3-Year Outcomes: Abciximab vs. Eptifibatide

Abbreviation: NACE, net adverse clinical events (any MACE or major bleeding event excluding those related to CABG).

Study Details

Compared with patients treated with eptifibatide, those treated with abciximab were more likely to be female, have Killip class III or IV heart failure on presentation, have higher baseline rates of TIMI grade 0 or 1 flow, have lower baseline platelet counts, and have longer symptom-to-balloon times. Conversely, patients treated with eptifibatide had higher rates of previous PCI and CABG and use of femoral vascular access and closure devices.

Note: Dr. Dangas and several coauthors are faculty members of the Cardiovascular Research Foundation, which owns and operates TCTMD.

Disclosures:

• The study was sponsored by the Cardiovascular Research Foundation under an investigational device exemption from the US Food and Drug Administration with funding from Boston Scientific and The Medicines Company.
• Dr. Dangas reports receiving honoraria from Boston Scientific, Bristol-Myers Squibb, Sanofi-Aventis, and The Medicines Company.

Related Stories:

• HORIZONS-AMI Published: Bivalirudin, Taxus Stay Strong at 3 Years
• Studies Show Eptifibatide Equivalent to Abciximab During PCI for STEMI
• Eptifibatide Does Not Help, May Harm Primary PCI Patients Pretreated with Clopidogrel

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