Comparison of Catheterization Laboratory Initiated Abciximab and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes (an ACUITY Substudy)


Kirtane, AJ; Parise, H; Mehran, R; Moses, JW; Fahy, M; Bertrand, ME; Ohman, EM; White, HD; Feit, F; Colombo, A; McLaurin, BT; Cox, DA; Ware, JH; Pocock, SJ; Lansky, AJ; Stone, GW; (2010) Comparison of Catheterization Laboratory Initiated Abciximab and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes (an ACUITY Substudy). The American journal of cardiology, 106 (2). pp. 180-186. ISSN 0002-9149 DOI: https://doi.org/10.1016/j.amjcard.2010.03.015

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Abstract

Abciximab and eptifibatide have been shown to reduce ischemic complications compared with heparin alone in patients with acute coronary syndromes who undergo percutaneous coronary intervention. Whether 1 agent is safer and/or more effective has not been prospectively examined. The aim of this study was to assess the outcomes related to downstream glycoprotein IIIb/IIIa inhibitor treatment selection during percutaneous coronary intervention in 2,211 patients with moderate and high-risk acute coronary syndromes in the prospective multicenter Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. The protocol permitted operator selection of abciximab (n = 835) or eptifibatide (n = 1,376) for routine use in the trial. Multivariate and propensity-based adjustments were used to assess the independent association of glycoprotein IIb/IIIa inhibitor treatment selection with prespecified study end points. Compared to patients receiving eptifibatide, those administered abciximab were older, more likely to be enrolled outside of North America, more frequently had biomarker elevations and ST-segment deviation, but had fewer baseline cardiac risk factors and previous revascularization procedures. After multivariate propensity-based adjustment, abciximab was independently associated with significantly fewer net clinical adverse events (odds ratio 0.61, 95% confidence interval 0.42 to 0.90, p = 0.01), mediated by composite ischemia (odds ratio 0.61, 95% confidence interval 0.38 to 0.98, p = 0.04) and major bleeding (odds ratio 0.58, 95% confidence interval 0.34 to 1.00, p = 0.051). In conclusion, in this prespecified but nonrandomized comparison in patients with acute coronary syndromes who underwent percutaneous coronary intervention with catheterization laboratory initiation of glycoprotein IIb/IIIa inhibitors, the use of abciximab rather than eptifibatide was associated with improved clinical outcomes at 30 days. These findings should be viewed as exploratory in light of the nonrandomized and heterogenous nature of the comparator groups and significant potential for residual confounding. (C) 2010 Published by Elsevier Inc. (Am J Cardiol 2010;106:180-186)

Item Type: Article
Keywords: GLYCOPROTEIN IIB/IIIA INHIBITORS, MYOCARDIAL-INFARCTION, PLATELET, INHIBITION, ADJUNCTIVE THERAPY, CONTROLLED TRIAL, TARGET TRIAL, TIROFIBAN, ANGIOPLASTY, RECEPTOR, SAFETY, Acute Coronary Syndrome, therapy, Aged, Angioplasty, Transluminal, Percutaneous Coronary, Antibodies, Monoclonal, therapeutic use, Female, Humans, Immunoglobulin Fab Fragments, therapeutic use, Male, Middle Aged, Peptides, therapeutic use, Platelet Aggregation Inhibitors, therapeutic use, Severity of Illness Index, Treatment Outcome
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 20599000
Web of Science ID: 280131100007
URI: http://researchonline.lshtm.ac.uk/id/eprint/3160

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