TY  - BOOK
AU  - Baker, Nevin C
AU  - Escarcega, Ricardo O
AU  - Lipinski, Michael J
AU  - Magalhaes, Marco A
AU  - Torguson, Rebecca
AU  - Waksman, Ron
TI  - Safety of eptifibatide when added to bivalirudin during ST-segment elevation myocardial infarction
SN  - 1878-0938
PY  - 2014///
KW  - *Antithrombins/tu [Therapeutic Use]
KW  - *Myocardial Infarction/dt [Drug Therapy]
KW  - *Peptide Fragments/tu [Therapeutic Use]
KW  - *Peptides/tu [Therapeutic Use]
KW  - *Platelet Aggregation Inhibitors/tu [Therapeutic Use]
KW  - Adult
KW  - Aged
KW  - Aged, 80 and over
KW  - Angioplasty, Balloon, Coronary/mt [Methods]
KW  - Drug Therapy, Combination
KW  - Female
KW  - Hirudins
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Myocardial Infarction/pp [Physiopathology]
KW  - Myocardial Infarction/su [Surgery]
KW  - Percutaneous Coronary Intervention
KW  - Recombinant Proteins/tu [Therapeutic Use]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available in print through MWHC library: 2002 - present
N2  - 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; 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; 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; 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)
UR  - http://dx.doi.org/10.1016/j.carrev.2014.06.001
ER  -