Abstract 4945: Eptifibatide is Non-inferior to Abciximab in Acute Coronary Syndromes: Results From the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
Introduction: Glycoprotein IIb/IIIa inhibitors are recommended by international guidelines with high level of evidence in patients with Acute Coronary Syndromes (ACS) undergoing treatment with percutaneous coronary interventions. No prospective randomized trial comparing abciximab and eptifibatide has been published.
Hypothesis: We hypothesized that eptifibatide is non-inferior to abciximab.
Methods: We included all ACS patients in Sweden undergoing percutaneous coronary interventions receiving either eptifibatide or abciximab during 2004 to 2006 from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). The primary endpoint was death and myocardial (re-)infarction during one year follow-up with adjustment for baseline differences with a multivariable logistic regression analysis including propensity score. The pre-specified non-inferiority margin was set to 1.29.
Results: ACS patients were stratified in two treatment groups (eptifibatide n=3703 and abciximab n=10252) which showed similar baseline characteristics with mean age of 65 years, female representation of 27% and diabetes in 20.5% respectively 19.4%. The eptifibatide cohort had a lower proportion of ST-elevation myocardial infarctions (45.8% vs. 67.6%). The combined endpoint occurred in 543 (14.7%) and 1607 (15.7 %) of eptifibatide and abciximab treated patients respectively. The unadjusted odds ratio (95 %CI) for eptifibatide versus abciximab was 0.92 [0.83 – 1.03]. Multivariable adjustment (n=13882) showed non-inferiority with an odds ratio of 1.07 [0.95 – 1.19]. In patients with ST-elevation myocardial infarctions the non-inferiority remained with adjusted odds ratio of 1.03 [0.89 – 1.20] (n=8598).
Conclusions: This large scale registry study shows that eptifibatide is non-inferior to abciximab as adjunctive therapy in invasively managed ACS patients with respect to death or myocardial infarction during one year, justifying its broad use in clinical practice.