Eptifibatide vs Abciximab in Primary PCI for Acute STEMI -- The Randomized EVA-AMI Study
Presenter: Uwe Zeymer, MD (Institute fur Herzinfarktforschung Ludwigshafen, Germany)
A large number of randomized, controlled studies performed in the late 1990s demonstrated that the GP IIb/IIIa inhibitor abciximab reduces ischemic complications in patients undergoing primary PCI. Eptifibatide, another GP IIb/IIIa inhibitor, has shown similar event reductions in patients undergoing elective PCI to those of abciximab. To date, no large prospective head-to-head comparison between these GP IIb/IIIa inhibitors in the primary PCI setting has been conducted.
Aim and Study Design
The Eptifbatide vs Abciximab in Primary PCI for Acute ST Elevation Myocardial Infarction (EVA-AMI) trial was an international randomized study designed to demonstrate the non-inferiority of eptifibatide vs abciximab as an adjunctive treatment for patients undergoing primary PCI.
Patients with an STEMI <12 hours who were treated with aspirin, clopidogrel, and unfractionated heparin or enoxaparin and scheduled for primary PCI were randomized to receive either:
Eptifibatide double bolus and 24 hour infusion; or
Abciximab bolus plus 12 hour infusion
Primary endpoint: Complete ST resolution (>70%) at 60 minutes.
Secondary endpoints: Death, reinfarction, target vessel revascularization, and bleeding complications.
A total of 429 patients were randomized in the study. Baseline characteristics were well-balanced between the 2 groups, with no differences in time from symptom onset to study medication or time to angiography ( Table 3 ).
TIMI 3 blood flow at the end of the procedure was present in 84.3% of patients treated with abciximab and 82.4% of patients treated with eptifibatide (P = NS). Complete ST resolution was achieved in 59.6% and 63.1% of patients in the abciximab and eptifbatide groups, respectively (Figure 3). Secondary endpoints and major and minor bleeding complications were also similar in both arms of the study ( Table 4 ).
EVA-AMI: ST resolution at 60 minutes.
Eptifibatide given as a double bolus is equally effective as adjunct to primary PCI with respect to myocardial reperfusion.
The preliminary clinical events did not show any differences between the 2 GP IIb/IIIa agents.
Eptifibatide may be an alternative to abciximab in patients undergoing primary PCI in the acute STEMI setting.
Medscape Cardiology © 2008 Medscape
Cite this: Adjunctive Therapy in ACS Patients: TRITON-TIMI 38, EVA-AMI, and BRIEF-PCI - Medscape - Feb 14, 2008.