Benefit of bolus-only platelet glycoprotein IIb/IIIa inhibition during percutaneous coronary intervention: Insights from the very early outcomes in the Evaluation of 7E3 for the Prevention of Ischemic Complications (EPIC) trial

Randomized, double‐blind comparison of effects of abiciximab bolus only vs. on‐label regimen on ex vivo inhibition of platelet aggregation in responders to clopidogrel undergoing coronary stenting

“…The cumulative rate of major adverse cardiac events was similarly reduced in the bolus-only arm (2.9%) and bolus + infusion arm (2.4%) as compared with placebo (5.3%) within the first 6 h after intervention [3]. However, higher rates of myocardial infarction and urgent target vessel revascularization were noted thereafter in the bolus arm as compared with bolus + infusion throughout 30 days [3].…”

“…In the EPIC study, an abciximab bolusonly strategy was compared with both placebo and the current on-label abciximab regimen of bolus followed by12-h infusion in patients undergoing balloon angioplasty and receiving concomitant treatment with aspirin and unfractionated heparin [2]. The cumulative rate of major adverse cardiac events was similarly reduced in the bolus-only arm (2.9%) and bolus + infusion arm (2.4%) as compared with placebo (5.3%) within the first 6 h after intervention [3]. However, higher rates of myocardial infarction and urgent target vessel revascularization were noted thereafter in the bolus arm as compared with bolus + infusion throughout 30 days [3].…”

Drive-Through Angioplasty

“…A recent reanalysis of the EPIC data examined outcomes at 6-hour intervals during the first 24 hours after balloon angioplasty to identify any benefit in the group receiving only the abciximab bolus. 18 At 6 hours, the primary composite end point (death, myocardial infarction, or urgent intervention) was reduced by 46% with an abciximab bolus only compared with placebo (2.9% versus 5.3%), mainly because of a reduced rate of urgent intervention. Such a post hoc analysis can only be considered thought provoking and hypothesis generating at this point, however.…”

Outpatient percutaneous coronary intervention: Ready for prime time?

“…First, the ischemic risk is related to acute vessel closure and its morbidity and mortality consequences. Several reports have shown that acute vessel closure can occur in 5% to 20% of cases after percutaneous transluminal coronary angioplasty (PTCA), most of these events occurring during the first 24 h to 48 h post-PTCA (7,8). Beyond 48 h, the incidence of ischemic events has been reported to decrease exponentially (9).…”