Abstract 17531: Two-Year Clinical Results Comparing Abciximab vs. Eptifibatide in Combination With 600mg vs. 300mg Clopidogrel Loading Dose in Patients With ST-Elevation Myocardial Infarction: Results from the HORIZONS-AMI Trial
Background: Platelet GPIIb/IIIa receptor inhibitors (GPI), abciximab (A) and eptifibatide (E), are commonly used in patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency angiography and percutaneous coronary intervention (PCI). Administration of the ADP receptor inhibitor clopidogrel is also indicated in STEMI. There are no comparative data on the types of GPI agents in combination with high or low (600 mg vs. 300 mg) clopidogrel loading doses.
Methods: In this sub-study of the HORIZONS-AMI trial, we examined the 2-year clinical outcomes of STEMI patients treated in the heparin plus GPI study arm stratified by the loading dose of clopidogrel. We compared the 4 groups: A+clopidogrel 600 mg (A+C600, n= 612), A+clopidogrel 300 mg (A+C300, n= 346), E+clopidogrel 600 mg (E+C600, n= 565), and E+clopidogrel 300 mg (E+C300, n= 276). Major bleeding, major adverse events (MACE=death, reinfarction, target vessel revascularization (TVR), and stroke), and net adverse clinical events (NACE= MACE and major bleeding) were obtained.
Results: All four groups had similar baseline ventricular function, conjunctive anti-thrombotic therapies, initial TIMI flow, and lesion severity. Among A+C600, A+C300, E+C600, E+C300, significant differences included hypertension (51%, 58%, 60%, 51%; p=0.007), diabetes (14%, 20%, 18%, 19%; p=0.10), LAD vessel PCI (37%, 46%, 45%, 42%; p=0.003), and closure device use (29%, 15%, 37%, 27%;p=0.001). At 30-day and 2-year follow-up, there were no differences in outcomes by univariate analysis (Table). Multivariate analysis controlling for baseline risks will be presented.
Conclusion: Patients with STEMI treated with heparin, GPI, and clopidogrel showed similar bleeding risks and clinical efficacy after 2-year follow-up by univariate analysis, regardless of GPI type or clopidogrel loading dose combinations.
- © 2010 by American Heart Association, Inc.