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Rathod KS, Antoniou S, Avari P, Ding N, Wright P, Knight C, Jain AK, Mathur A, Smith EJ, Weerackody R, Wragg A, Jones DA. Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients. JRSM Cardiovasc Dis 2017; 6:2048004017734431. [PMID: 29051816 PMCID: PMC5637964 DOI: 10.1177/2048004017734431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. METHODS This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups. RESULTS In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73-1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79-1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71-1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000). CONCLUSION This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when used in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- K S Rathod
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Clinical Pharmacology, Queen Mary University, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - S Antoniou
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Pharmacy, Barts Health NHS Trust, London, UK
| | - P Avari
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - N Ding
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - P Wright
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Pharmacy, Barts Health NHS Trust, London, UK
| | - C Knight
- Department of Cardiology, Barts Health NHS Trust, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - A K Jain
- Department of Cardiology, Barts Health NHS Trust, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - A Mathur
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Clinical Pharmacology, Queen Mary University, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - E J Smith
- Department of Cardiology, Barts Health NHS Trust, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - R Weerackody
- Department of Cardiology, Barts Health NHS Trust, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - A Wragg
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Clinical Pharmacology, Queen Mary University, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
| | - D A Jones
- Department of Cardiology, Barts Health NHS Trust, London, UK.,Department of Clinical Pharmacology, Queen Mary University, London, UK.,NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK
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Krysko AA, Kornylov AY, Polishchuk PG, Samoylenko GV, Krysko OL, Kabanova TA, Kravtsov VC, Kabanov VM, Wicher B, Andronati SA. Synthesis, biological evaluation and molecular docking studies of 2-piperazin-1-yl-quinazolines as platelet aggregation inhibitors and ligands of integrin αIIbβ3. Bioorg Med Chem Lett 2016; 26:1839-43. [DOI: 10.1016/j.bmcl.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 02/03/2023]
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Krysko AA, Samoylenko GV, Polishchuk PG, Fonari MS, Kravtsov VC, Andronati SA, Kabanova TA, Lipkowski J, Khristova TM, Kuz'min VE, Kabanov VM, Krysko OL, Varnek AA. Synthesis, biological evaluation, X-ray molecular structure and molecular docking studies of RGD mimetics containing 6-amino-2,3-dihydroisoindolin-1-one fragment as ligands of integrin αIIbβ₃. Bioorg Med Chem 2013; 21:4646-61. [PMID: 23757209 DOI: 10.1016/j.bmc.2013.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/01/2013] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Abstract
A series of novel RGD mimetics containing phthalimidine fragment was designed and synthesized. Their antiaggregative activity determined by Born's method was shown to be due to inhibition of fibrinogen binding to αIIbβ₃. Molecular docking of RGD mimetics to αIIbβ₃ receptor showed the key interactions in this complex, and also some correlations have been observed between values of biological activity and docking scores. The single crystal X-ray data were obtained for five mimetics.
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Affiliation(s)
- Andrei A Krysko
- A.V. Bogatsky Physico-Chemical Institute of the National Academy of Sciences of Ukraine, Lustdorfskaya Doroga 86, Odessa 65080, Ukraine.
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Iancu A, Ober C, Bondor CI, Cadiş H. Microvascular effect of intracoronary eptifibatide in acute myocardial infarction. Cardiology 2012; 123:46-53. [PMID: 22986471 DOI: 10.1159/000341197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/14/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this prospective, randomized trial in patients with acute myocardial infarction (AMI) admitted for primary percutaneous coronary intervention (PPCI), loaded with 600 mg clopidogrel, we hypothesized that eptifibatide administered downstream of the coronary occlusion leads to a lower degree of microvascular obstruction compared with no additional eptifibatide. METHODS Fifty patients with AMI, loaded with 600 mg of clopidogrel at the first hospital contact, with occlusion of the left anterior descending artery (LAD), were randomized to an eptifibatide group (EG) or a control group (CG). In both groups, stenting was performed after thrombus aspiration. Microvascular reperfusion was assessed by angiography, electrocardiography, and transthoracic Doppler ultrasonography of the LAD. RESULTS TIMI myocardial perfusion grade 2-3 was not different between the EG (72%) and the CG (84%) (p = 0.31). ST segment resolution >70% was similarly detected in both groups (32 vs. 40%; p = 0.56). The mean diastolic deceleration time did not differ significantly between the CG (856.36 ± 397.88 ms) and the EG (935.72 ± 252.22 ms) (p = 0.41). Multivariate logistic regression revealed no significant influence of the treatment with eptifibatide on ST segment resolution (OR 0.47; 95% CI 0.11-2.10, p = 0.32), TIMI myocardial perfusion (OR 0.52; 95% CI 0.10-2.59, p = 0.42), and diastolic deceleration time (OR 0.21; 95% CI 0.03-1.51, p = 0.12). CONCLUSIONS In AMI patients loaded with 600 mg of clopidogrel undergoing PPCI, intracoronary administration of eptifibatide does not clearly improve microvascular obstruction.
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Affiliation(s)
- Adrian Iancu
- 'Niculae Stăncioiu' Heart Institute, Cluj-Napoca, Romania
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