Abstract
Inhibition of platelet aggregation with glycoprotein (GP) IIb-IIIa receptor blockers
has been shown to reduce ischemic complications in patients with acute coronary syndromes
(ACS) and in those undergoing percutaneous coronary intervention (PCI) in multiple
placebo-controlled, randomized clinical trials. The effect of pharmacologic and cost
differences between abciximab and eptifibatide, the only GP IIb-IIIa inhibitors indicated
for PCI, on clinical outcomes and total hospital costs for patients undergoing PCI
remain to be defined. To determine the rate of clinical events and costs associated
with the use of abciximab vs eptifibatide at our centers, we retrospectively reviewed
data for the cohort of 188 consecutive patients who underwent PCI and were treated
with either abciximab (n = 85) or eptifibatide (n = 103) in the period between January
1998 and June 1999. The choice of a GP IIb-IIIa inhibitor was based on the preference
of the interventional cardiologist. In-hospital events evaluated included death, major
bleeding, minor bleeding, and hematoma. Additionally, the duration of hospital stay
and total in-hospital costs were also assessed. Clinical events at 6 months included
combined incidence of death, acute myocardial infarction (MI), or unstable angina
(UA), as well as the incidence of hospital readmissions. In-hospital complications
were generally more common with abciximab (death: 4.7% vs 0% with eptifibatide; major
bleeding: 7.1% vs 4.8%, respectively; minor bleeding: 9.4% vs 5.7%, respectively;
hematoma: 21.2% vs 21.4%, respectively), although none of these differences reached
statistical significance. However, abciximab therapy was associated with a significantly
longer mean duration of hospitalization (4.17 ± 0.48 days vs 2.85 ± 0.26 days with
eptifibatide; P = 0.017) and a significantly higher mean total in-hospital costs ($31,396
± 2,111 vs $25, 135 ± 815; P = 0.007). At six-month follow-up, the combined incidence
of death, acute MI, or UA was also significantly higher in the abciximab group (32.9%
vs 15.5%; P = 0.01). Additionally, hospital readmissions related to acute coronary
syndromes at 6 months occurred significantly more often in the abciximab group (36.7%
vs 16.5% with eptifibatide; P = 0.014). Our retrospective analysis of 188 patients
undergoing PCI indicates that the use of eptifibatide instead of abciximab is associated
with significantly lower in-hospital costs, significantly shorter duration of index
hospitalization, and significantly reduced rates of ischemic complications and cardiovascular
readmissions at 6-month follow-up. These differences were seen despite the fact that
the baseline characteristics of patients in the two groups were generally similar.
Therefore, eptifibatide provides a clinically effective and economically more attractive
alternative to abciximab.
