The Impact of Eptifibatide on Midterm Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Cohort Study

Abbas Andishmand; Hamid  Alian; Seyed Ali Banifatemeh

doi:10.18502/aptj.v5i3.20512

Abbas Andishmand Department of Cardiology, School of Medicine Afshar Heart Center- Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Hamid Alian Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Seyed Ali Banifatemeh Department of Cardiology, School of Medicine Afshar Heart Center- Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

DOI: https://doi.org/10.18502/aptj.v5i3.20512

Keywords: Eptifibatide, Primary PCI, STEMI, Cardiac death, Bleeding, TVR, Recurrent MI, MACE

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the standard reperfusion strategy for ST-elevation myocardial infarction (STEMI). Eptifibatide, a glycoprotein IIb/IIIa inhibitor, is used during primary PCI to reduce ischemic complications. However, its clinical benefit remains uncertain. This study aimed to compare the rates of cardiac death, recurrent myocardial infarction (MI), or target vessel revascularization (TVR) at 12 months between patients who received eptifibatide and those who did not.

Methods: A retrospective cohort study was performed on 268 STEMI patients who underwent primary PCI. Patients were divided into two groups: those who received eptifibatide (n=134) and those who did not (n=134). The primary endpoint was a composite of cardiac death, recurrent myocardial infarction, and TVR at 12 months. Secondary endpoints included the individual components of the primary endpoint and in-hospital major bleeding.

Results: Patients who received eptifibatide had a lower rate of major adverse cardiovascular events (MACEs) at 12 months than those who did not (11.2% vs 26.9%, p=0.001). Eptifibatide use was associated with lower rates of death (3% vs 11.2%, p=0.008), while rates of TVR (3.7% vs 8.2%, p=0.098) and recurrent MI (4.5% vs 7.5%, p=0.220) did not differ significantly between groups. The incidence of in-hospital major bleeding was not statistically significant (10.6% vs 4.5%, p=0.156). Comparison between groups showed significantly lower odds of cardiac death and of the composite major adverse cardiovascular events in patients who received eptifibatide (OR: 0.24, 95% CI: 0.08-0.76, p=0.015; and OR: 0.34, 95% CI: 0.18-0.66, p=0.001, respectively).

Conclusion: In STEMI patients undergoing primary PCI, administration of eptifibatide was associated with lower rates of death and MACE at 12 months without an increase in in-hospital major bleeding. Use of eptifibatide during primary PCI may improve mid-term outcomes.