Angioplasty: stenting: eptifibatide reduced death, myocardial infarction and need for revascularisation

Clinical bottom line (level 1b)

  1. Patients undergoing elective coronary artery stenting who received eptifibatide compared with placebo were less likely to die or have a myocardial infarction (NNT = 23 at 12 months) .
  2. Patients who received eptifibatide were less likely to die, have a myocardial infarction, or require target vessel revascularisation (NNT = 22 at 12 months) .
O'Shea et al: JAMA 2002; 287 : 618-621
O-Shea et al: JAMA 2001; 285 : 2468-2473
Expires March 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 92 tertiary hospitals, USA and Canada

2064 patients (aged median 62, 73% male) requiring non-urgent coronary angioplasty with stent implantation

Excluded if
  • acute myocardial infarction within previous 24 hours and ongoing chest pain
  • serum creatinine > 350 micromol/l
  • stroke or TIA within 30 days
  • history of haemorrhagic stroke; history of bleeding diatehsis or evidence of abnormal bleeding within 30 days
  • major surgery within previous 6 weeks
  • uncontrolled hypertension (> 200/100 mmHg)
  • thrombocytopenia (< 100 x 10 9 /l)
  • percutaneous coronary intervention within previous 90 days, or elective intervention within next 30 days
  • previous stent implantation at target location
  • treatment with thienopyridine or glycoprotein IIb/IIIa inhibitor within previous 30 days

Control Group: (n = 1024, 1024 analysed): placebo
Experimental Group: (n = 1040, 1040 analysed): eptifibatide two 180 microgm/kg bolus injections 10 minutes apart, followed by a continuous infusion of 2.0 microg/kg/min started with the first bolus and continued for 18 to 24 hours
All patients received aspirin and a weight-adjusted heparin regimen (bolus 60 units/kg followed by an infusion with a target activated clotting time 200 to 300 s). Treatment with clopidogrel or ticlopidine was allowed on the day of angioplasty.
95% followed for 12 months

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
death or myocardial infarction 12 months 127
(12.4%)		 83
(7.98%)		 36%
(16% to 51%)		 4.42%
(1.82% to 7.03%)		 23
(14 to 55)
death, myocardial infarction, or target vessel revascularisation 12 months 226
(22.1%)		 182
(17.5%)		 21%
(6% to 33%)		 4.57%
(1.14% to 8.00%)		 22
(12 to 88)

Citation

  1. O'Shea JC, Buller CE, Cantor WJ, et al: long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention (ESPRIT). JAMA 2002; 287 : 618-621
  2. O-Shea JC, Hafley GE, Greenberg S, et al: platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention. The ESPRIT trial: a randomized controlled trial. JAMA 2001; 285 : 2468-2473
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient elective angioplasty with stenting
Intervention or Exposure eptifibatide
Comparison placebo
Outcome death, myocardial infarction, revascularisation