Journal of Invasive Cardiology

Several clinical trials have demonstrated that platelet glycoprotein (GP) IIb/IIIa receptor inhibition reduces the ischemic complications of percutaneous coronary interventions (PCI).^1–4 Comparative data between agents, however, are very limited,⁵ and no large, randomized trials exist comparing the efficacy and safety of the two most commonly used agents, eptifibatide and abciximab. Based on clinical trials demonstrating a clear benefit of abciximab in high-risk patients^1,2,4 and a more modest benefit of eptifibatide use in the ESPRIT trial,⁴ a strategy for use of GP IIb/IIIa inhibitors during PCI with abciximab for high-risk patients and eptifibatide for lower-risk patients has been proposed.6 We previously reported results from a single-center observational study in acute coronary syndrome (ACS) patients undergoing PCI that early outcomes were superior with abciximab compared to eptifibatide.⁷
In addition to the clinical trials demonstrating a benefit of GP IIb/IIIa inhibitor use in the catheterization laboratory at the time of the PCI, there has also been increasing usage of GP IIb/IIIa inhibitors to treat patients with ACS in the early phase of their hospitalization.^8–10 Recent data suggest that in patients with high-risk ACS features that upstream use of a low-dose of tirofiban prior to and following PCI may be superior to high-dose bolus tirofiban or abciximab administered at the time of the PCI.¹¹ Whether the strategy of selective use of abciximab for high-risk ACS patients as noted above, after upstream use of eptifibatide, is superior to continued eptifibatide use for PCI, however, is uncertain. We report our experience of the selective use of abciximab for high-risk ACS patients following upstream use of eptifibatide and compare it to the use of eptifibatide for both upstream and PCI treatment of patients with ACS.