Effect of glycoprotein IIb/IIIa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial

OBJECTIVES We sought to determine whether eptifibatide decreases the incide nce of in-laboratory angiographic complications and to determine the relati onship of angiographically evident complications to elevations of creatine kinase-MB (CK-MB) enzyme levels during percutaneous coronary intervention. BACKGROUND In the Enhanced Suppression of the Platelet IIb/IIIa Receptor wi th Integrilin Therapy (ESPRIT) trial, eptifibatide during coronary interven tion was associated with decreased ischemic complications at 48 h and 30 da ys. METHODS Patients (n = 2,064) were randomized to placebo versus eptifibatide (two 180 mug/kg boluses 10 min apart and as a continuous infusion of 2;mug /kg per min) during percutaneous coronary stenting. Angiographic complicati ons including major dissection, distal embolization, residual thrombus, abr upt closure, residual stenosis > 50% and side-branch occlusion were prospec tively recorded by the operator. Creatine kinase-MB levels were measured af ter the procedure and every 6 h thereafter. The incidence of angiographic c omplications and CK-MB elevation was determined for eptifibatide versus pla cebo groups. RESULTS Eptifibatide-treated patients demonstrated nonsignificant trends to ward fewer angiographic complications (10 vs. 12% for placebo patients, p = 0.13) and, for patients with angiographic complications, fewer subsequent CK-MB elevations (43 vs. 50% for placebo patients, p = 0.31). In patients w ithout any angiographic complications, the incidence of CK-MB elevation >3 times the normal was 7% with placebo and 4% with eptifibatide (p = 0.003). CONCLUSIONS Eptifibatide during nonurgent coronary stent intervention only minimally (and insignificantly) reduces the incidence of angiographic compl ications and subsequent CK-MB elevations in patients developing an angiogra phic complication. The greater effect is to reduce myocardial infarction in patients undergoing otherwise uneventful coronary stent implantation as we ll as in the overall study population. (C) 2001 by the American College of Cardiology.