Monday, March 30, 2009

Late-breaking clinical trial: Early ACS results
By Kelly Winget, DCRI Communications

For patients who have acute coronary syndromes and need to have their arteries surgically widened to restore blood flow, it is recommended that they take glycoprotein inhibitors, such as eptifibatide, to help prevent blood clots and to help prevent blood vessels from re-narrowing after the procedures.

The DCRI's Kristin Newby, MD, led a new study to determine if it was better to treat patients with eptifibatide before or after they have an angiography test to determine how the blood is flowing in their heart.

The results were presented Monday at a late-breaking clinical trial session at the American College of Cardiology Annual Scientific Sessions. Results were also published online in the New England Journal of Medicine on March 30.

Researchers found that giving patients eptifibatide up to 12 hours before angiography was actually linked with a greater risk of bleeding that was not life-threatening, and an increased need for a blood transfusion.

Acute coronary syndrome is chest pain caused by decreased blood flow to the heart, and it can include heart attacks. For the study, 9,492 patients who had acute coronary syndromes but did not have changes in their heart rhythm that showed up on an ECG test were randomized to receive eptifibatide at least 12 hours before angiography, or to receive a placebo and the drug after angiography if necessary.

Researchers found that patients who received the drug before angiography had almost the same risk of death or heart attack as the patients who received the placebo prior to the angiography and eptifibatide after the test, but before undergoing angioplasty to insert a stent into the blocked arteries. There was also no significant difference for a risk of serious bleeding among the two groups.

Based on the study results, researchers note that maybe it should not be routine procedure to treat patients who are over 75 years old with early eptifibatide doses. Researchers also note that because of the increased risk of bleeding, clinicians should weigh that risk against the potential benefit of treating patients with eptifibatide before undergoing angioplasty, but the researchers do not recommend that treating patients with eptifibatide early should be routine practice.

Other DCRI researchers involved with the study include Jennifer White, MS; Lisa Berdan, PA, MHS; Kerry Lee, Phd; Bob Harrington, MD; and Rob Califf, MD.

Click here to read the full results.