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(Circulation. 2000;102:2952.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Enhanced Efficacy of Eptifibatide Administration in Patients With Acute Coronary Syndrome Requiring In-Hospital Coronary Artery Bypass Grafting

Steven P. Marso, MD; Deepak L. Bhatt, MD; Matthew T. Roe, MD; Penny L. Houghtaling, MS; Marino Labinaz, MD; Neal S. Kleiman, MD; Cornelius Dyke, MD; Maarten L. Simmoons, MD; Robert M. Califf, MD; Robert A. Harrington, MD; Eric J. Topol, MD; for the PURSUIT Investigators

From the Mid America Heart Institute (S.P.M.), Saint Luke’s Hospital, Kansas City, Mo; the Department of Cardiology (D.L.B., E.J.T.) and the Department of Biostatistics and Epidemiology (P.L.H.), The Cleveland Clinic Foundation, Cleveland, Ohio; the Ottawa Heart Institute (M.L.), Ottawa, Canada; the Division of Cardiology (M.T.R., R.M.C., R.A.H.), Duke Clinical Research Institute, Durham, NC; the Division of Cardiology (N.S.K.), Baylor College of Medicine, Houston, Tex; the Sanger Clinic (C.D.), Charlotte, NC; and Erasmus University (M.L.S.), Rotterdam, the Netherlands.

Correspondence to Steven P. Marso, MD, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail smarso{at}saint-lukes.org

Background—Patients with a recent episode of non–ST-segment elevation acute coronary syndrome before CABG have higher rates of operative morbidity and mortality than patients with stable coronary syndromes. The efficacy of administering eptifibatide to these patients undergoing in-hospital CABG is unknown.

Methods and Results—The Platelet Glycoprotein IIb-IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial randomized 10 948 patients to receive either eptifibatide or placebo. There were 1558 study participants who underwent in-hospital CABG: 692 received placebo, and 866 received eptifibatide. The main substudy analysis end point was death or myocardial infarction (MI) rates at the 6-month follow-up. The 30-day death or MI rates were 30.8% and 26.1% for the placebo and eptifibatide groups, respectively (P=0.041). The benefit of eptifibatide administration persisted through 6-months of follow-up (32.7% versus 27.6% for placebo versus eptifibatide, respectively; P=0.029). There was a greater reduction in the 6-month death or MI rate for patients who received eptifibatide within 72 hours of CABG (33.6% versus 23.8%; P=0.002) compared with the >72-hour group (31.6% versus 32%; P=1.0). The incidence of major bleeding was 56.6% for placebo-treated patients versus 58.2% for eptifibatide-treated patients (P=0.7).

Conclusions—Eptifibatide administration in patients undergoing in-hospital CABG with a recent episode of a non–ST-segment elevation acute coronary syndrome results in a significant reduction in death or MI that is evident at 7 days and persists through the 6-month follow-up without a significant increase in perioperative bleeding rates.

Key Words: coronary disease • platelets • grafting • glycoproteins

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