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EARLY ACS: Routine vs. delayed provisional use of eptifibatide may improve patient outcomes
Wang T. Circulation. 2011;123;722-730.
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New data have shown that patients with non–ST-elevation acute coronary syndrome who used early eptifibatide besides clopidogrel before angiography had lower rates of 30-day mortality and MI compared with those who used eptifibatide on a delayed provisional basis.
Investigators of the Early Glycoprotein IIb/IIIa Inhibition in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome (EARLY-ACS) trial included 9,166 patients with non–ST-elevation ACS who underwent angiography, of which 7,068 patients received upstream clopidogrel (Plavix, Sanofi-Aventis).
At 96 hours after invasive strategy, 9.2% of patients who received early eptifibatide (Integrilin, Millennium/Schering) vs. 9.6% of patients treated with the delayed provisional strategy experienced the primary endpoint of death, MI, recurrent ischemia requiring urgent revascularization or thrombotic bailout, whereas at 30 days, the difference in the secondary endpoint in death or MI was slightly more pronounced in favor of early use (10.9% vs. 12.1%; adjusted HR=0.90).
Furthermore, a significant reduction in death or MI at 30 days was reported in patients receiving upstream clopidogrel who also received early eptifibatide vs. delayed provisional (adjusted OR=0.85, 95% CI 0.73-0.99), but not in patients without intended upstream clopidogrel use.
“These findings lend support to the concept of enhanced value for additive antiplatelet therapies,” the researchers concluded. “Future investigations are needed to identify those patients who may benefit from more intensive platelet inhibition without a significant excess in bleeding risk.”
EARLY ACS was funded by research grants from Schering-Plough and Merck Pharmaceuticals.
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