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Is glycoprotein IIb/IIIa antagonism as effective in women as in men following percutaneous coronary intervention?.
Laura S Fernandes1, James E Tcheng, J Conor O'Shea
1Baylor College of Medicine and the Methodist DeBakey Heart Center, Houston Texas 77030, USA.
Insights
Eptifibatide effectively prevents ischemic complications after percutaneous coronary interventions (PCI) in both women and men. This platelet glycoprotein IIb/IIIa antagonist may help reduce gender-based outcome differences in PCI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Eptifibatide is a glycoprotein (GP) IIb/IIIa antagonist known to reduce ischemic complications.
- Previous studies demonstrated its efficacy in non-urgent coronary stent interventions.
Purpose of the Study:
- To determine if eptifibatide prevents ischemic complications following percutaneous coronary interventions (PCIs).
- To assess the efficacy of eptifibatide in both female and male patients undergoing PCI.
Main Methods:
- The study analyzed data from the Enhanced Suppression of the Platelet GP IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial.
- Outcomes were compared between women (n=562) and men (n=1,502) who received double-bolus eptifibatide during PCI.
Main Results:
- Women were older and had more comorbidities, but fewer prior interventions. At 48 hours, the composite endpoint occurred in 10.5% of women vs. 7.9% of men (p=0.082). At one year, this composite occurred in 24.5% of women vs. 18% of men (p=0.0008).
- Eptifibatide significantly reduced ischemic events in women at 48 hours (14.5% to 6.0%) and one year (28.9% to 20.0%), compared to men (9.0% to 6.8% at 48h; 19.5% to 16.6% at 1yr).
- Bleeding events were more frequent in women (5.5% vs. 2.6%, p=0.002), particularly with eptifibatide. No significant interaction between gender and treatment was observed after adjustments.
Conclusions:
- Eptifibatide is effective in preventing ischemic complications associated with PCI.
- The drug shows potential in mitigating gender-related disparities in PCI outcomes.
- Further research may be warranted to optimize its use considering bleeding risks in women.
Objective:
The study was done to determine whether eptifibatide, a platelet glycoprotein (GP) IIb/IIIa antagonist, prevents ischemic complications following percutaneous coronary interventions (PCIs) in women as well as in men.
Background:
Eptifibatide reduces ischemic complications after nonurgent coronary stent interventions.
Methods:
We compared outcomes in women (n = 562) and men (n = 1,502) enrolled in the Enhanced Suppression of the Platelet GP IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial of double-bolus eptifibatide during PCI.
Results:
Women in the ESPRIT trial were older, and more frequently had hypertension, diabetes mellitus, or acute coronary syndromes, but were less likely to have prior PCI or coronary artery bypass graft surgery. The primary end point, a composite at 48 h of death, myocardial infarction (MI), urgent target vessel revascularization (TVR), and unplanned GP IIb/IIIa use, occurred in 10.5% of women and 7.9% of men (p = 0.082). The composite of death, MI, or TVR after one year occurred in 24.5% of women compared with 18% of men (p = 0.0008). At 48 h, eptifibatide reduced the composite of death, MI, and TVR from 14.5% to 6.0% in women versus 9.0% to 6.8% in men. At one year, these differences persisted: 28.9% versus 20.0% for women and 19.5% versus 16.6% for men. No statistical interaction existed between treatment and gender at either 48 h (p = 0.063) or one year (p = 0.2). Bleeding occurred more commonly in women (5.5% vs. 2.6%, p = 0.002), and was more common in eptifibatide-treated women. After adjustment for age, weight, and hypertension, no interaction between treatment and gender was present.
Conclusion:
Eptifibatide is effective to prevent ischemic complications of PCI in women and may eliminate gender-related differences in PCI outcomes.