New research indicates that early outcomes of primary percutaneous coronary intervention (PCI) are comparable for patients treated with eptifibatide or abciximab.
A pooled analysis of data from previous trials has suggested that survival may be improved when patients are treated with abciximab. Whether eptifibatide, which is widely used in the community, offers a suitable alternative to abciximab, however, was unclear.
The present study[1] involved an analysis of data from a large regional registry of contemporary PCI. Included were 729 patients who were treated with abciximab and 2812 given eptifibatide, senior author Dr. Mauro Moscucci, from the University of Michigan Health System at Ann Arbor, and colleagues note.
Rates of in-hospital death, recurrent MI, and stroke/transient ischemic attack did not differ significantly between the groups, at about 4.0, 1.0, and 0.7 per cent, respectively.
The need for blood transfusion was also similar in abciximab- and eptifibatide-treated patients (12.4 vs. 11.7 per cent, p = NS), although abciximab was associated with a higher rate of gastrointestinal bleeding (4.8 vs. 2.8 per cent, p = 0.01).
In a related editorial, Dr. David J. Moliterno and Dr. Khaled M. Ziada, from the University of Kentucky in Lexington, agree with the researchers noting that the "findings are not adequate to prove non-inferiority of eptifibatide compared with abciximab in primary PCI."
They add that "a very large and expensive trial" would be needed to prove non-inferiority, which is unlikely to ever be done. Still, the bulk of evidence suggests that small molecule platelet glycoprotein IIb/IIIa inhibitors, like eptifibatide, offer "no clear disadvantage compared with abciximab."
[1]
J Am Coll Cardiol 2008;51:529-537.
