Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention

J. Conor O'Shea, Christopher E. Buller, Warren J. Cantor, A. Bleakley Chandler, Eric A. Cohen, David J. Cohen, Ian Gilchrist, Neal S. Kleiman, Marino Labinaz, Mina Madan, Gail E. Hafley, Robert M. Califf, Michael M. Kitt, John Strony, James E. Tcheng

Research output: Contribution to journalArticle

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Abstract

Context: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days. Objective: To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention. Design and Setting: The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada. Participants: A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation. Intervention: Patients were randomly assigned to receive placebo (n=1024) or eptifibatide (two 180-μg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 μg/kg per minute; n=1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine. Main Outcome Measures: Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment. Results: Complete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P=.001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P=.007). Conclusions: Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.

Original languageEnglish (US)
Pages (from-to)618-621
Number of pages4
JournalJournal of the American Medical Association
Volume287
Issue number5
StatePublished - Feb 6 2002

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Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Integrins
Stents
Placebos
Myocardial Infarction
Blood Platelets
Confidence Intervals
eptifibatide
Mortality
Percutaneous Coronary Intervention
Therapeutics
Tertiary Care Centers
Cross-Over Studies
Infarction
Aspirin
Canada
Heparin
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Conor O'Shea, J., Buller, C. E., Cantor, W. J., Bleakley Chandler, A., Cohen, E. A., Cohen, D. J., ... Tcheng, J. E. (2002). Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention. Journal of the American Medical Association, 287(5), 618-621.
Conor O'Shea, J. ; Buller, Christopher E. ; Cantor, Warren J. ; Bleakley Chandler, A. ; Cohen, Eric A. ; Cohen, David J. ; Gilchrist, Ian ; Kleiman, Neal S. ; Labinaz, Marino ; Madan, Mina ; Hafley, Gail E. ; Califf, Robert M. ; Kitt, Michael M. ; Strony, John ; Tcheng, James E. / Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention. In: Journal of the American Medical Association. 2002 ; Vol. 287, No. 5. pp. 618-621.
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abstract = "Context: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days. Objective: To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention. Design and Setting: The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada. Participants: A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation. Intervention: Patients were randomly assigned to receive placebo (n=1024) or eptifibatide (two 180-μg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 μg/kg per minute; n=1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine. Main Outcome Measures: Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment. Results: Complete follow-up data were available for 988 patients given eptifibatide (95.0{\%}) and 976 patients given placebo (95.3{\%}). By 12 months, the composite of death or MI had occurred in 8.0{\%} of eptifibatide-treated patients and in 12.4{\%} of placebo-treated patients (hazard ratio [HR], 0.63; 95{\%} confidence interval [CI], 0.48-0.83; P=.001). The composite rate of death, MI, or target vessel revascularization was 17.5{\%} in eptifibatide-treated patients vs 22.1{\%} in placebo-treated patients (HR, 0.76; 95{\%} CI, 0.63-0.93; P=.007). Conclusions: Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.",
author = "{Conor O'Shea}, J. and Buller, {Christopher E.} and Cantor, {Warren J.} and {Bleakley Chandler}, A. and Cohen, {Eric A.} and Cohen, {David J.} and Ian Gilchrist and Kleiman, {Neal S.} and Marino Labinaz and Mina Madan and Hafley, {Gail E.} and Califf, {Robert M.} and Kitt, {Michael M.} and John Strony and Tcheng, {James E.}",
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Conor O'Shea, J, Buller, CE, Cantor, WJ, Bleakley Chandler, A, Cohen, EA, Cohen, DJ, Gilchrist, I, Kleiman, NS, Labinaz, M, Madan, M, Hafley, GE, Califf, RM, Kitt, MM, Strony, J & Tcheng, JE 2002, 'Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention', Journal of the American Medical Association, vol. 287, no. 5, pp. 618-621.

Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention. / Conor O'Shea, J.; Buller, Christopher E.; Cantor, Warren J.; Bleakley Chandler, A.; Cohen, Eric A.; Cohen, David J.; Gilchrist, Ian; Kleiman, Neal S.; Labinaz, Marino; Madan, Mina; Hafley, Gail E.; Califf, Robert M.; Kitt, Michael M.; Strony, John; Tcheng, James E.

In: Journal of the American Medical Association, Vol. 287, No. 5, 06.02.2002, p. 618-621.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention

AU - Conor O'Shea, J.

AU - Buller, Christopher E.

AU - Cantor, Warren J.

AU - Bleakley Chandler, A.

AU - Cohen, Eric A.

AU - Cohen, David J.

AU - Gilchrist, Ian

AU - Kleiman, Neal S.

AU - Labinaz, Marino

AU - Madan, Mina

AU - Hafley, Gail E.

AU - Califf, Robert M.

AU - Kitt, Michael M.

AU - Strony, John

AU - Tcheng, James E.

PY - 2002/2/6

Y1 - 2002/2/6

N2 - Context: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days. Objective: To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention. Design and Setting: The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada. Participants: A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation. Intervention: Patients were randomly assigned to receive placebo (n=1024) or eptifibatide (two 180-μg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 μg/kg per minute; n=1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine. Main Outcome Measures: Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment. Results: Complete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P=.001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P=.007). Conclusions: Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.

AB - Context: In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, treatment with eptifibatide, a platelet glycoprotein IIb/IIIa integrin blocker, was found to reduce the ischemic complications of nonurgent coronary stent implantation at 48 hours and 30 days. Objective: To determine whether eptifibatide treatment continues to provide durable, long-term benefit after coronary stent intervention. Design and Setting: The ESPRIT trial was a randomized, double-blind, placebo-controlled, parallel-group, crossover-permitted trial conducted from June 1999 through February 2000 at 92 tertiary care centers in the United States and Canada. Participants: A total of 2064 patients scheduled to undergo nonurgent percutaneous coronary intervention with stent implantation. Intervention: Patients were randomly assigned to receive placebo (n=1024) or eptifibatide (two 180-μg/kg boluses, 10 minutes apart, with a continuous infusion of 2.0 μg/kg per minute; n=1040), started immediately before stent implantation and continued for 18 to 24 hours. Patients also received aspirin, heparin, and a thienopyridine. Main Outcome Measures: Composite rates of death or myocardial infarction (MI) and death, infarction, or target vessel revascularization during the 12 months after enrollment. Results: Complete follow-up data were available for 988 patients given eptifibatide (95.0%) and 976 patients given placebo (95.3%). By 12 months, the composite of death or MI had occurred in 8.0% of eptifibatide-treated patients and in 12.4% of placebo-treated patients (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.48-0.83; P=.001). The composite rate of death, MI, or target vessel revascularization was 17.5% in eptifibatide-treated patients vs 22.1% in placebo-treated patients (HR, 0.76; 95% CI, 0.63-0.93; P=.007). Conclusions: Long-term outcomes of nonurgent coronary stent implantation appear to be improved through blockade of the platelet glycoprotein IIb/IIIa integrin with eptifibatide.

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Conor O'Shea J, Buller CE, Cantor WJ, Bleakley Chandler A, Cohen EA, Cohen DJ et al. Long-term efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention. Journal of the American Medical Association. 2002 Feb 6;287(5):618-621.