BRIEF-PCI study

Eptifibatide infusion for <2 hours after uncomplicated nonemergent stenting yields similar benefits with significantly lesser major bleeding vs. standard 18-hour infusion: BRIEF-PCI study

Background

It is unknown whether shorter duration of eptifibatide infusion in uncomplicated nonemergent percutaneous coronary intervention (PCI) can prevent ischemic events.

Aim

To assess whether early discontinuation of eptifibatide in uncomplicated nonemergent PCI with stenting is associated with greater periprocedural ischemic myonecrosis.

Patients

Stable angina, acute coronary syndrome (ACS) or recent ST elevation myocardial infarction (MI) >48 hours undergoing coronary stenting (N=624)

Study Groups

Short duration of eptifibatide: 2 ?g/kg/min for <2 hours (mean 1.4 hours) after PCI (N=312)
Usual duration of eptifibatide: 2 ?g/kg/min for 18 hours (mean 16.8 hours) after PCI (N=312)
All patients received standard double bolus of 180 ?g/kg eptifibatide 10 minutes apart, clopidogrel, aspirin and unfractionated heparin/enoxaparin

Primary Efficacy Outcome

Ischemic myocardial necrosis within 24 hours of PCI

Results

Incidence of ischemic myocardial necrosis was similar in patients receiving shorter duration of eptifibatide vs. usual duration (Figure 1) and did not differ in subgroups such as diabetes, clopidogrel pretreatment, ACS or recent MI
Composite end-point of death, MI and target vessel revascularization (TLR) at 30 days was also similar in both groups (Figure 1)
Figure 1. Effect on myonecrosis and death, MI & TLR

Incidence of major bleeding was nearly 4-fold lesser in patients receiving short duration of eptifibatide (Figure 2)

Figure 2. Incidence of major bleeding

After uncomplicated nonemergent PCI with stenting, post-procedural infusion of eptifibatide < 2 hours yields similar benefits on periprocedural myonecrosis with significantly lesser bleeding as compared to standard 18-hour infusion.

These results along with currently available data indicate that double bolus of eptifibatide followed with short duration of infusion after PCI is an attractive alternative to bivalirudin for PCI

-Mahumad E & Prasad A, in a related editorial

J Am Coll Cardiol 2009;53:837-45, 846-8

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