Abbreviated eptifibatide bolus-only regimen noninferior to, safer than conventional approach
11 Jan 2021
Add-on eptifibatide, infused intravenously, seems to be unnecessary for the adjunctive antithrombotic treatment during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI), a recent study has found.
Instead, an abbreviated bolus administration of eptifibatide appears to be sufficient, providing noninferior improvements in terms of infarct size, and leading to lower rates of bleeding complications.
The study included 720 STEMI patients who were given eptifibatide treatment either through an abbreviated bolus-only (n=147; mean age, 62.4±11.3 years; 24 percent female) approach or conventionally, where an infusion followed the bolus administration (mean age, 60.5±10.5 years; 19 percent female). Outcomes included infarct size and major bleeding.
Myocardial infarct size, assessed through peak myocardial bound creatine kinase (CK-MB) values, was comparable in the abbreviated- and conventional-treatment arms (204±149 vs 238±173 IU/L; relative difference, –8.4 percent, 95 percent confidence interval [CI], –31.2 to 14.4). The same was true for peak CK values.
In particular, the upper limits of both peak CK-MB and CK did not breach the 20-percent prespecified noninferiority margin, indicating that the bolus-only approach was indeed noninferior to the conventional treatment regimen.
Resolution of ST-segment in electrocardiography also occurred comparably between groups (relative difference, 3.6 percent, 95 percent CI, –5.5 to 12.8).
On the other hand, major bleeding complications occurred at a significantly lower frequency in patients receiving the abbreviated treatment (32 percent vs 47 percent; p=0.01), corresponding to a 52-percent drop in the risk of such complications (odds ratio, 0.48, 95 percent CI, 0.29–0.79).