A Randomized Trial to Evaluate the Relative Protection Against Post-Percutaneous Coronary Intervention Microvascular Dysfunction, Ischemia, and Inflammation Among Antiplatelet and Antithrombotic Agents
| Autor: | David A. Morrow, Peter Stone, Carolyn H. McCabe, Theresa M. Palabrica, Henry H. Lui, Polly Fish, Eugene Braunwald, C. Michael Gibson, Sabina A. Murphy, Lisa K. Jennings, Nasser Lakkis, David J. Cohen, Richard Kovach, Thomas M Bulle |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Percutaneous coronary intervention Coronary flow reserve medicine.disease Angina Internal medicine Conventional PCI medicine Eptifibatide Cardiology Bivalirudin cardiovascular diseases Myocardial infarction Cardiology and Cardiovascular Medicine business TIMI medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 47:2364-2373 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2005.12.077 |
| Popis: | OBJECTIVES The goal of this study was to evaluate glycoprotein IIb/IIIa inhibition with eptifibatide when administered with indirect thrombin inhibition as compared with monotherapy with direct thrombin inhibition with bivalirudin among patients with non-ST-segment elevation acute coronary syndromes (ACS). BACKGROUND The optimal combination of antiplatelet and antithrombin regimens that maximizes efficacy and minimizes bleeding among patients with non-ST-segment elevation ACS undergoing percutaneous coronary intervention (PCI) is unclear. METHODS A total of 857 patients with non-ST-segment elevation ACS were assigned randomly to eptifibatide + reduced dose unfractionated heparin (n = 298), eptifibatide + reduced-dose enoxaparin (n = 275), or bivalirudin monotherapy (n = 284). RESULTS Among angiographically evaluable patients (n = 754), the primary end point of post-PCI coronary flow reserve was significantly greater with bivalirudin (1.43 vs. 1.33 for pooled eptifibatide arms, p = 0.036). Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade more often was normal with eptifibatide treatment compared with bivalirudin (57.9% vs. 50.9%, p = 0.048). The duration of ischemia on continuous Holter monitoring after PCI was significantly longer among patients treated with bivalirudin (169 vs. 36 min, p = 0.013). There was no excess of TIMI major bleeding among patients treated with eptifibatide compared with bivalirudin (0.7%, n = 4 vs. 0%, p = NS), but TIMI minor bleeding was increased (2.5% vs. 0.4%, p = 0.027) as was transfusion (4.4% to 0.4%, p < 0.001). CONCLUSIONS Among moderate- to high-risk patients with ACS undergoing PCI, coronary flow reserve was greater with bivalirudin than eptifibatide. Eptifibatide improved myocardial perfusion and reduced the duration of post-PCI ischemia but was associated with higher minor bleeding and transfusion rates. Ischemic events and biomarkers for myonecrosis, inflammation, and thrombin generation did not differ between agents. |
| Databáze: | OpenAIRE |
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