Citation: Cardiovascular Revascularization Medicine. 15(5):278-83, 2014 Jul-Aug..Journal: Cardiovascular revascularization medicine : including molecular interventions.ISSN: 1878-0938.Full author list: Baker NC; Escarcega RO; Magalhaes MA; Lipinski MJ; Torguson R; Waksman R.UI/PMID: 25178667.Subject(s): Adult | Aged | Aged, 80 and over | Angioplasty, Balloon, Coronary/mt [Methods] | *Antithrombins/tu [Therapeutic Use] | Drug Therapy, Combination | Female | Hirudins | Humans | Male | Middle Aged | *Myocardial Infarction/dt [Drug Therapy] | Myocardial Infarction/pp [Physiopathology] | Myocardial Infarction/su [Surgery] | *Peptide Fragments/tu [Therapeutic Use] | *Peptides/tu [Therapeutic Use] | Percutaneous Coronary Intervention | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Recombinant Proteins/tu [Therapeutic Use]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: http://dx.doi.org/10.1016/j.carrev.2014.06.001 (Click here)Abbreviated citation: Cardiovasc Revasc Med. 15(5):278-83, 2014 Jul-Aug.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: BACKGROUND: Patients presenting with ST-segment elevation myocardial infarction (STEMI) represent a high-risk group for in-hospital adverse events and bleeding. The safety and outcomes of eptifibatide in addition to bivalirudin in this population have not been determined.Abstract: METHODS: Over an 11-year period, we identified 1849 STEMI patients undergoing primary percutaneous coronary intervention (PCI), of which 1639 received bivalirudin monotherapy compared with 210 patients who received both bivalirudin and provisional eptifibatide. Safety of combination therapy was assessed by the occurrence of thrombolysis in myocardial infarction (TIMI) major bleeding. In-hospital event rates of death, Q-wave myocardial infarction (MI), and acute stent thrombosis were evaluated for efficacy. Multivariate analysis was used to adjust for significant differences between groups.Abstract: RESULTS: Patients treated with bivalirudin plus eptifibatide, when compared with patients with bivalirudin monotherapy, had increased rates of cardiogenic shock (15.7% vs. 9.4%), aspiration thrombectomy (48.5% vs. 23.7%), pre-TIMI flow <1 (63.5% vs. 40%), and higher peak troponin I (93.65+/-92.7 vs. 49.16+/-81.59; all p <0.01). These, however, were not associated with differences in the primary end point after adjusting for significant baseline and procedural characteristics (OR: 1.63; 95% CI, 0.90-2.96, p=0.12). Importantly, TIMI major bleeding was not significantly different between groups (OR 1.78; 95% CI, 0.79-2.95, p=0.20).Abstract: CONCLUSION: The addition of eptifibatide to bivalirudin during primary PCI reflects a high-risk STEMI population. This therapy results in similar in-hospital outcomes without an increase in major bleeding. Therefore, when required, combination therapy may be considered in this population.Copyright � 2014 Elsevier Inc. All rights reserved.