Comparison of abciximab versus eptifibatide during percutaneous coronary intervention in ST-segment elevation
Harsimran S Singh1, George D Dangas, Giulio Guagliumi
1Columbia University Medical Center, New York, New York.
Insights
Eptifibatide and abciximab demonstrated comparable clinical efficacy and bleeding risks in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. This 3-year follow-up study found no significant differences in major adverse cardiovascular events or major bleeding between the two glycoprotein IIb/IIIa inhibitors.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Limited comparative safety and effectiveness data exist for glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention.
- The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial provides a platform for such comparisons.
Purpose of the Study:
- To compare the 3-year clinical and bleeding outcomes of eptifibatide versus abciximab in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
- To evaluate major adverse cardiovascular events (MACEs), major bleeding, and net adverse clinical events (NACEs) between the two treatment groups.
Main Methods:
- Substudy of the HORIZONS-AMI trial involving patients treated with heparin plus either abciximab or eptifibatide.
- Propensity score matching created comparable groups (671 patients each) for analysis.
- Multivariate analysis assessed outcomes including mortality, reinfarction, revascularization, stroke, and bleeding events at 3-year follow-up.
Main Results:
- No significant differences were observed in 3-year MACEs (18.3% vs 19.6%), major bleeding (10.7% vs 11.9%), or NACEs (24.5% vs 25.5%) between eptifibatide and abciximab.
- Multivariate analysis confirmed comparable outcomes for NACEs, MACEs, and major bleeding between the two agents.
- Propensity-matched groups also exhibited similar clinical and bleeding event rates.
Conclusions:
- Abciximab and eptifibatide exhibit comparable clinical efficacy and bleeding risks in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
- The findings support the use of either agent in this patient population, based on the available comparative data.
Abstract:
There are limited safety and effectiveness data comparing glycoprotein IIb/IIIa inhibitors in the setting of primary percutaneous coronary intervention. In this substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, the clinical and bleeding outcomes of eptifibatide versus abciximab were evaluated in patients with ST-segment elevation myocardial infarction who underwent percutaneous coronary intervention. Three-year clinical outcomes of patients in the heparin plus glycoprotein IIb/IIIa inhibitor arm were compared according to treatment with abciximab (n = 907) versus eptifibatide (n = 803). Adjudicated end points included major adverse cardiovascular events (MACEs; mortality, reinfarction, ischemia-driven target vessel revascularization, or stroke), major bleeding, and net adverse clinical events (MACEs or major bleeding). Propensity score matching was used to identify 1,342 matched cases (671 each in the abciximab and eptifibatide groups). Multivariate analysis was performed in the entire cohort and the propensity-matched groups. At 3-year follow-up, eptifibatide and abciximab resulted in nonsignificantly different rates of MACEs (18.3% vs 19.6%, hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.74 to 1.16, p = 0.51), major bleeding (10.7% vs 11.9%, HR 0.90, 95% CI 0.67 to 1.19, p = 0.44), and net adverse clinical events (24.5% vs 25.5%, HR 0.96, 95% CI 0.79 to 1.17, p = 0.69). Similarly, at 3 years by multivariate analysis, there was no statistically significant difference between abciximab and eptifibatide for net adverse clinical events (HR 0.89, 95% CI 0.73 to 1.09, p = 0.27), MACEs (HR 0.96, 95% CI 0.77 to 1.20, p = 0.73), and major bleeding (HR 1.05, 95% CI 0.78 to 1.41, p = 0.75). The propensity-matched groups also had similar outcomes. In conclusion, abciximab and eptifibatide have comparable bleeding risks and clinical efficacy in primary percutaneous coronary intervention.
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