Comparative 30-day economic and clinical outcomes of platelet glycoproteinIIb/IIIa inhibitor use during elective percutaneous coronary intervention:Prairie ReoPro Versus Integrilin Cost Evaluation (PRICE) Trial

Objectives This studs examined the economics, pharmacodynamics, and clinica l outcomes among patients randomly assigned to receive either abciximab (Re oPro, Centocor, Inc, Malvern, Pa, and Eli Lilly & Company, Indianapolis, In d) or eptifibatide (Integrilin, COR Therapeutics, inc, South San Francisco, Calif, and Key Pharmaceuticals, Inc, Kenilworth, NJ) therapy during electi ve percutaneous coronary intervention (PCI). Background Clinical and safety outcomes after elective PCI with a high-dose eptifibatide treatment strategy have not previously been systematically ev aluated. In addition, comparative economic and pharmacodynamic studies of p latelet glycoprotein (GP) IIb/IIIa receptor antagonists during PCI are spar se. Methods This randomized, double-blind study assessed the 30-day economic an d clinical outcomes of 320 consecutive patients undergoing elective coronar y balloon angioplasty or stent implantation who were randomly assigned to r eceive adjunct abciximab (n = 163) or eptifibatide (n = 157) therapy. The p rimary study end point was total in-hospital costs based on an intention-to -treat analysis. A secondary end point included 30-day total hospital costs . A platelet aggregometry sub-study was performed on 155 patients (abcixima b: n = 74 and eptifibatide: n = 81) with use of the Ultegra Rapid Platelet Function Assay. Results Baseline demographic, angiographic, and procedural variables were s imilar between the two treatment groups. The median and interquartile range s of total in-hospital costs were $8268 ($6505, $9958) and $7207 ($5659, $9 307), respectively, between the abciximab- and eptifibatide-treated patient s (P = .009). Median total costs at 30 days were $8336 ($6505, $10,126) and $7207 ($5659, $9431), respectively, between the abciximab- and eptifibatid e-treated groups (P = .009). The composite secondary clinical end points (d eath/nonfatal myocardial infarction/urgent revascularization) occurred in 4 .9% versus 5.1% of patients, respectively, by hospital discharge (P = .84) and in 5.6% versus 6.3% of patients, respectively, at 30 days (P = .95) in the abciximab and eptifibatide groups. With the eptifibatide dose used, ear ly and more durable platelet inhibition was achieved compared with abcixima b (P < .00001). Conclusion In drug dosages and patients similar to those enrolled in the cu rrent study, eptifibatide achieved durable platelet inhibition throughout d rug infusion and was associated with lower in-hospital and 30-day costs com pared with abciximab in patients undergoing elective PCI.