Short-term comparative outcomes associated with the use of GP IIb/IIIa antagonists in patients undergoing coronary intervention

Background: Platelet glycoprotein (GP) IIb/IIIa antagonists reduce the occu rrence of death, myocardial infarction (MI) and urgent revascularization am ong patients undergoing percutaneous coronary intervention (PCI). Despite a similar mechanism of platelet inhibition, the three currently approved age nts vary widely in cost. Purpose: The purpose of this prospectively designed, retrospective analysis was to determine clinical outcomes for patients receiving abciximab, tirof iban or eptifibatide as adjunctive therapy during PCI at a single center. W e hypothesized that there would be no difference in outcomes during hospita lization following PCI in patients receiving tirofiban or eptifibatide comp ared with those patients who received abciximab. Outcomes examined included in-hospital mortality, hemorrhagic procedural complications, need for reca theterization, peak creatine kinase following intervention and length of ho spital stay (LOS). Results: Two hundred and sixty seven consecutive patients in whom GP IIb/II Ia antagonist therapy was initiated in the catheterization laboratory for P CI were analyzed. Abciximab-treated patients were more likely to be undergo ing primary (p <0.001) and rescue (p=0.022) PCI and to have received fibrin olytic therapy (p=0.013) when compared to patients receiving tirofiban or e ptifibatide. There were no significant differences between abciximab- and n on abciximab-treated patients in either the primary PCI or non primary PCI groups in any of the studied endpoints. In patients undergoing primary PCI, abciximab-treated patients when compared with non abciximab-treated patien ts exhibited a trend toward an increase in hospital LOS (7.8 +/-7.0 d vs 6. 2 +/-3.9, p=0.19) and in the frequency of hemmorhagic complications (22.1% vs 5.3%, p=0.11). In patients not receiving fibrinolytic therapy, abciximab -treated patients experienced a trend toward increased hemmorhagic complica tions following PCI when compared to non abciximab-treated patients (10.2% vs 6.0%, p=0.28). Complications distant from the vascular access site compr ised 62.5% of hemmorhagic complications in the abciximab-treated group, but only 20% of the complications in the non-abciximab treated population (p < 0.001). These data suggest no differences in acute outcomes between groups of patients receiving abciximab or other approved GP IIb/IIIa antagonists h ighlighting a potential significant cost saving. These data will require in terpretation following the publication of comparative trials.