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Clinical outcomes comparing eptifibatide and abciximab in ST elevation acute myocardial infarction patients
Mark G Midei1, Vicki J Coombs, David R Lowry
1Midatlantic Cardiovascular Associates, Baltimore, MD 21204, USA.
Insights
Eptifibatide and abciximab show similar safety and efficacy in ST segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Eptifibatide offers a cost-effective alternative, maintaining beneficial outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Randomized trials often exclude ST segment elevation myocardial infarction (STEMI) patients when comparing glycoprotein IIb-IIIa inhibitors.
- This study addresses a gap in understanding treatment efficacy in STEMI populations.
Purpose of the Study:
- To compare in-hospital and 6-month clinical outcomes of eptifibatide versus abciximab in STEMI patients undergoing percutaneous coronary intervention (PCI).
- To evaluate the safety and efficacy of these agents in a real-world STEMI patient cohort.
Main Methods:
- An open-label, sequential comparison of registry data from STEMI patients receiving eptifibatide or abciximab during PCI.
- In-hospital outcomes and 6-month follow-up for major adverse cardiac events and functional status were assessed.
Main Results:
- No significant differences were observed in key in-hospital outcomes including reinfarction, repeat revascularization, bleeding, heart failure, stroke, renal failure, and mortality at discharge.
- Six-month all-cause mortality was also similar between the eptifibatide (6.5%) and abciximab (6.4%) groups (HR 0.976; 95% CI 0.43-2.23).
Conclusions:
- Eptifibatide and abciximab demonstrate comparable clinical outcomes in STEMI patients undergoing PCI.
- Given eptifibatide's lower cost, it presents a viable and cost-effective substitute for abciximab without compromising safety or efficacy.
Background:
Randomized clinical trials comparing glycoprotein IIb-IIIa inhibitors have largely excluded patients with ST segment elevation myocardial infarction (STEMI).
Methods:
We conducted an open-label, sequential comparison of in-hospital and 6-month clinical outcomes in STEMI patients receiving eptifibatide or abciximab as adjunctive therapy during percutaneous coronary intervention (PCI). Registry data were collected and compared for STEMI patients undergoing PCI and receiving eptifibatide or abciximab over a 3.5-year period. Six-month follow-up, using telephone interviews, included major adverse cardiac events and functional status.
Results:
Baseline characteristics were similar for patients receiving eptifibatide (n = 294) or abciximab (n = 158). No significant differences in hospital clinical outcomes were observed for reinfarction (2 vs. 3% for eptifibatide and abciximab, respectively), repeat revascularization (3 vs. 4%), bleeding complications (8 vs. 12%), congestive heart failure (5 vs. 3%), cerebrovascular accidents (0 vs. 2%), renal failure (2 vs. 3%), and all-cause mortality at discharge (5 vs. 4%). No significant difference was seen between groups in all-cause mortality at 6 months (6.5 vs. 6.4%; hazard ratio 0.976; 95% confidence interval 0.43-2.23; log-rank, p = 0.95).
Conclusions:
No significant differences were observed in clinical outcomes between STEMI patients receiving eptifibatide or abciximab in the setting of PCI. Considering the substantially lower cost of eptifibatide, these data suggest that eptifibatide can be substituted for abciximab to lower overall medication costs while maintaining beneficial safety and efficacy effects.
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