Abstract 2830: Comparison of Catheterization Lab Initiated Abciximab and Double-Bolus Eptifibatide during Percutaneous Coronary Intervention in Acute Coronary Syndromes: an ACUITY Substudy
Background. Both abciximab (AB) and double-bolus eptifibatide (EP) have been shown to reduce ischemic complications compared to heparin alone in pts with acute coronary syndromes (ACS) undergoing PCI. Whether one agent is safer and/or more effective has not been examined.
Methods. Outcomes from the prospective multicenter ACUITY trial were examined in 2211 pts with moderate and high risk ACS who were randomized to and received heparin (unfractionated or enoxaparin) or bivalirudin plus routine cath lab initiation of GPIIb/IIIa inhibitors for PCI. The protocol permitted operator selection of AB (n=835) or double-bolus EP (n=1376). Multivariable and propensity-based adjustment were used to assess the independent association of AB or EP treatment upon pre-specified study endpoints at 30 days.
Results. AB pts were more frequently enrolled outside of North America, while EP patients were more frequently enrolled within North America. AB pts were older, but had fewer baseline cardiac risk factors or prior revascularization procedures. Baseline biomarker elevation and ST-segment deviation were more prevalent among AB pts. In unadjusted analyses, treatment with AB was associated with less frequent composite ischemia (death/MI/unplanned revascularization: 7.2% vs. 11.2% for EP, p=0.002), similar rates of major bleeding (5.9% vs. 6.8%, p=0.37), and thus reduced combined net clinical outcomes (11.9% vs. 16.3%, p=0.004). After multivariable propensity-based adjustment including enrollment geography as a covariate, AB was independently associated with lower odds of composite ischemia and net clinical outcomes (Table⇓).
Conclusions. In this pre-specified but non-randomized comparison among ACS pts undergoing PCI with cath lab initiation of GPIIb/IIIa inhibitors, the use of AB compared to double-bolus EP resulted in improved clinical outcomes. While observational in nature, these data justify further comparative study of these agents in a randomized trial.