Adjunctive Therapy in ACS Patients: TRITON-TIMI 38, EVA-AMI, and BRIEF-PCI

Luis Gruberg, MD, FACC


February 14, 2008

In This Article

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 ).

Figure 3.

EVA-AMI: ST resolution at 60 minutes.


  1. Eptifibatide given as a double bolus is equally effective as adjunct to primary PCI with respect to myocardial reperfusion.

  2. The preliminary clinical events did not show any differences between the 2 GP IIb/IIIa agents.

  3. Eptifibatide may be an alternative to abciximab in patients undergoing primary PCI in the acute STEMI setting.


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