Effect of eptifibatide on angiographic complications during percutaneous coronary intervention in the IMPACT-(Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis) II trial

We sought to determine whether eptifibatide reduces elevation of creatine k inase (CK)-MB isoenzyme release during coronary intervention by preventing angiographic complications, by minimizing the sequelae of angiographic comp lications once they occur, or by other mechanisms. In the Integrilin to Min imize Platelet Aggregation and Coronary Thrombosis trial, patients underwen t coronary intervention during treatment with placebo versus the glycoprote in IIb/IIIa receptor inhibitor eptifibatide. Eptifibatide decreased ischemi c complications at 24 hours and 30 days. CK-MB elevations and in-laboratory angiographic complications (including major dissection, distal embolizatio n, residual thrombus, abrupt closure, residual stenosis >50%, and side bran ch occlusion) were prospectively recorded. The incidence of any angiographi c complication was lower in eptifibatide-treated patients (33%) than in pla cebo-treated patients (38%, p = 0.019). For patients with angiographic comp lications, there was a trend toward a reduced incidence of any elevation in CK-MB in the first 24 hours (29%, 135/0.75 eptifibatide dose; 33%, 135/0.5 eptifibatide dose; 37%, placebo). Among patients without angiographic comp lications, there was a similar trend toward fewer abnormal CK-MB levels in patients receiving eptifibatide (17% and 18% in eptifibatide arms vs 21% pl acebo). Thus, eptifibatide reduces angiographically evident complications d uring coronary intervention, but this effect accounts for only 1/3 of the r educed frequency of CK-MB elevations observed with eptifibatide. When angio graphic complications occur, eptifibatide reduces rates of subsequent CK-MB elevation, accounting for another 1/3 of the reduction in CK-MB elevations . Finally, eptifibatide reduces the incidence of periprocedural CK-MB eleva tions in patients without angiographically evident complications, accountin g for 1/3 of eptifibatide's overall effect in reducing of CK-MB elevations in patients undergoing percutanous coronary intervention. (C)2001 by Excerp ta Medica, Inc.