Long‐term mortality after bolus‐only administration of abciximab, eptifibatide, or tirofiban during percutaneous coronary intervention

Objective: To evaluate the long‐term mortality after bolus‐only administration of abciximab, eptifibatide, and tirofiban during percutaneous coronary intervention (PCI). Background: Studies on platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) administered as bolus‐only during PCI suggest that this strategy may be similar in efficacy, safer, and more cost‐effective compared to a bolus plus infusion of GPI. Methods: We evaluated 864 patients (abciximab = 274, eptifibatide = 361, and tirofiban = 229) who underwent PCI with a bolus‐only regimen during January 2003 to August 2005. Results: After a median follow up of four (interquartile range, 3–4.5) years, there were a total of 95 (11%) deaths. The survival rate was 83% in the abciximab group, 91% in the eptifibatide group, and 93% in the tirofiban group ( P = 0.003 by log‐rank test). After adjustment for baseline clinical and procedural characteristics using a Cox proportional hazards model, the abciximab group had a significantly higher mortality compared to the eptifibatide group ( P = 0.003; Hazard ratio (HR) for eptifibatide compared to abciximab was 0.49 (95% confidence intervals [CI]: 0.30–0.78). The long‐term mortality was not significantly different in the tirofiban group compared to the abciximab group ( P = 0.33) or the eptifibatide group ( P = 0.20), perhaps because of shorter follow‐up period and fewer patients in the tirofiban group. Conclusion: When given as bolus‐only during PCI, eptifibatide may improve long‐term survival compared to abciximab. © 2009 Wiley‐Liss, Inc.