Context The Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin
Therapy (ESPRIT) trial showed the efficacy of adjunctive, double-bolus eptifibatide
therapy in reducing ischemic complications of nonurgent coronary stent implantation
at 48 hours and at 30 days.
Objective To determine whether the beneficial effects of eptifibatide persist
at 6 months after treatment.
Design Follow-up study of a randomized, double-blind, placebo-controlled, crossover-permitted
trial conducted from June 1999 through February 2000.
Setting Ninety-two tertiary care centers in the United States and Canada.
Participants A total of 2064 patients scheduled to undergo nonurgent percutaneous
coronary intervention with stent implantation.
Intervention Patients were randomly assigned to receive placebo or eptifibatide (two
180-µg/kg boluses 10 minutes apart and continuous infusion of 2.0 µg/kg
per minute), started immediately before stent implantation and continued for
18 to 24 hours. Complete follow-up data were available for 988 (95.0%) of
1040 patients given eptifibatide and 977 (95.4%) of 1024 patients given placebo.
Main Outcome Measures Composite rates of death or myocardial infarction (MI); death, MI, or
target vessel revascularization; and their individual components 6 months
after enrollment, compared between the 2 groups.
Results By 6 months, the composite end point of death or MI had occurred in
7.5% of eptifibatide-treated patients and in 11.5% of placebo-treated patients
(hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47-0.84; P = .002). The composite of death, MI, or target vessel revascularization
was 14.2% in eptifibatide-treated patients vs 18.3% in placebo-treated patients
(HR, 0.75; 95% CI, 0.60-0.93; P = .008). Most of
this benefit accrued early (<48 hours after initiation of therapy) and
was maintained through 6 months. Six-month mortality in the eptifibatide group
was 0.8% vs 1.4% in the placebo group (HR, 0.56; 95% CI, 0.24-1.34; P = .19) and target vessel revascularization occurred in
8.6% of the eptifibatide group vs 9.4% of the placebo group (HR, 0.91; 95%
CI, 0.68-1.22; P = .51).
Conclusion Adjunctive eptifibatide therapy during coronary stent implantation provides
benefit through 6-month follow-up.