EurekaMag.com logo
+ Site Statistics
References:
53,869,633
Abstracts:
29,686,251
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial



Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial



Lancet 356(9247): 2037-2044



Background: The platelet glycoprotein IIb/IIIa inhibitors, although effective in reducing ischaemic complications of percutaneous coronary intervention, are used in few coronary stent implantation procedures. ESPRIT (Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy) is a randomised, placebo-controlled trial to assess whether a novel, double-bolus dose of eptifibatide could improve outcomes of patients undergoing coronary stenting. Methods: We recruited 2064 patients undergoing stent implantation in a native coronary artery. Immediately before percutaneous coronary intervention, patients were randomly allocated to receive eptifibatide, given as two 180 mug/kg boluses 10 min apart and a continuous infusion of 2.0 mug/kg/min for 18-24 h, or placebo, in addition to aspirin, heparin, and a thienopyridine. The primary endpoint was the composite of death, myocardial infarction, urgent target vessel revascularisation, and thrombotic bailout glycoprotein IIb/IIIa inhibitor therapy within 48 h after randomisation. The key secondary endpoint was the composite of death, myocardial infarction, or urgent target vessel revascularisation at 30 days. Findings: The trial was terminated early for efficacy. The primary endpoint was reduced from 10.5% (108 of 1024 patients on placebo (95% CI 8.7-12.4%)) to 6.6% (69 of 1040 (5.1-8.1%)) with treatment (p=0.0015). The key 30 day secondary endpoint was also reduced, from 10.5% (107 of 1024 patients on placebo (8.6-12.3%)) to 6.8% (71 of 1040 (5.3-8.4%); p=0.0034). There was consistency in reduction of events across all components of the composite endpoint and among the major subgroups. Major bleeding was infrequent but arose more often with eptifibatide than placebo (1.3%, 13 of 1040 (0.7-2.1%)) vs 0.4%, 4 of 1024 (0.1-1.0%); p=0.027). Interpretation: Routine glycoprotein IIb/IIIa inhibitor pretreatment with eptifibatide substantially reduces ischaemic complications in coronary stent intervention and is better than a strategy of reserving treatment to the bailout situation.

(PDF emailed within 0-6 h: $19.90)

Accession: 011071818

Download citation: RISBibTeXText

PMID: 11145489

DOI: 10.1016/S0140-6736(00)03400-0



Related references

Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomized placebo-controlled study. Indian Heart Journal 53(3): 376-376, 2001

Treatment effects of eptifibatide in planned coronary stent implantation in patients with chronic kidney disease (ESPRIT Trial). American Journal of Cardiology 91(1): 17-21, 2002

Treatment effects of eptifibatide in planned coronary stent implantation in patients with chronic kidney disease (ESPRIT trial). American Journal of Cardiology 91(1): 17-21, 2003

Design and methodology of the ESPRIT trial: evaluating a novel dosing regimen of eptifibatide in percutaneous coronary intervention. American Heart Journal 140(6): 834-839, 2000

Eptifibatide in coronary stent implantation Long-term results of the ESPRIT trial. Circulation 104(17 Supplement): II 94, October 23, 2001

High-dose eptifibatide in coronary stent implantation 1 Year results of the ESPRIT trial. Journal of the American College of Cardiology 37(2 Supplement A): 76A, February, 2001

High-dose eptifibatide in coronary stent implantation 6 Month results of the ESPRIT trial. Circulation 102(18 Supplement): II 663, October 31, 2000

High-dose eptifibatide in elective coronary stent implantation Results of the ESPRIT trial. European Heart Journal 21(Abstract Supplement): 146, August-September, 2000

Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: The ESPRIT trial: A randomized controlled trial. JAMA (Journal of the American Medical Association) 285(19): 2468-2473, May 16, 2001

In-hospital costs of coronary stent implantation with and without eptifibatide (the ESPRIT Trial). Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin. American Journal of Cardiology 89(1): 61-64, 2002

Effect of Eptifibatide on coronary flow reserve following coronary stent implantation (An ESPRIT substudy). American Journal of Cardiology 87(11): 1293-1295, 2001

Cost-effectiveness of eptifibatide in patients undergoing planned coronary stenting Results from the ESPRIT trial. Circulation 104(17 Supplement): II 386-II 387, October 23, 2001

Effect of eptifibatide on coronary flow reserve following coronary stent implantation (an ESPRIT substudy). Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy. American Journal of Cardiology 87(11): 1293-1295, 2001

Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Lancet (North American Edition) 349(9063): 1422-1428, 1997