This Article Full Text Full Text (PDF) All Versions of this Article: 2/4/330    most recent CIRCINTERVENTIONS.108.847582.108.847582v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Le May, M. R. Articles by Labinaz, M. Search for Related Content PubMed PubMed Citation Articles by Le May, M. R. Articles by Labinaz, M. Related Collections Acute myocardial infarction Catheter-based coronary interventions: stents Platelet function inhibitors

Original Articles

Primary Percutaneous Coronary Angioplasty With and Without Eptifibatide in ST-Segment Elevation Myocardial Infarction

A Safety and Efficacy Study of Integrilin-Facilitated Versus Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction (ASSIST)

Michel R. Le May, MD; George A. Wells, PhD; Chris A. Glover, MD; Derek Y. So, MD; Michael Froeschl, MD; Jean-François Marquis, MD; Edward R. O'Brien, MD; Michele Turek, MD; Allyson Thomas, RN; Malek Kass, MD; Sachin Jadhav, MD and Marino Labinaz, MD

From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada.

Correspondence to Michel R. Le May, MD, Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7. E-mail mlemay{at}ottawaheart.ca

Received December 28, 2008; accepted June 9, 2009.

Background— Primary percutaneous coronary intervention, if performed promptly, is the preferred strategy to restore flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. We sought to determine whether eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor, given before catheterization would improve clinical outcomes in patients referred for primary percutaneous coronary intervention.

Methods and Results— We randomly assigned a total of 400 patients with ST-segment elevation myocardial infarction referred for primary percutaneous coronary intervention to treatment initiated before cardiac catheterization, with either heparin plus eptifibatide (201 patients) or heparin alone (199 patients), in addition to oral aspirin (160 mg) and high-dose clopidogrel (600 mg). The primary end point was a composite of death from any cause, recurrent myocardial infarction, or recurrent severe ischemia during the first 30 days after randomization. At 30 days, the primary end point was reached by 13 patients (6.47%) assigned to heparin plus eptifibatide and by 11 patients (5.53%) assigned to heparin alone (relative risk, 1.18; 95% CI, 0.52 to 2.70; P=0.69). The rates of major or minor bleeding were higher in patients assigned to heparin plus eptifibatide than that in patients assigned to heparin alone (22.4% versus 14.6%; relative risk, 1.69; 95% CI, 1.01 to 2.83; P=0.04).

Conclusions— In patients pretreated with high-dose clopidogrel who were referred for primary PCI, treatment with heparin plus eptifibatide, when compared with heparin alone, did not improve clinical outcomes and was associated with more bleeding complications.

Key Words: myocardial infarction • primary percutaneous angioplasty • platelets • eptifibatide

---

 

CLINICAL PERSPECTIVE