Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients

K S Rathod; S Antoniou; P Avari; N Ding; P Wright; C Knight; A K Jain; A Mathur; E J Smith; R Weerackody; A Wragg; D A Jones

doi:10.1177/2048004017734431

Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients

JRSM Cardiovasc Dis. 2017 Oct 5:6:2048004017734431. doi: 10.1177/2048004017734431. eCollection 2017 Jan-Dec.

Authors

K S Rathod^{1

2

3}, S Antoniou^{1

4}, P Avari¹, N Ding¹, P Wright^{1

4}, C Knight^{1

3}, A K Jain^{1

3}, A Mathur^{1

2

3}, E J Smith^{1

3}, R Weerackody^{1

3}, A Wragg^{1

2

3}, D A Jones^{1

2

3}

Affiliations

¹ Department of Cardiology, Barts Health NHS Trust, London, UK.
² Department of Clinical Pharmacology, Queen Mary University, London, UK.
³ NIHR Cardiovascular Biomedical Research Centre, Barts Health NHS Trust, London, UK.
⁴ Department of Pharmacy, Barts Health NHS Trust, London, UK.

Abstract

Introduction: Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Methods: This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups.

Results: In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73-1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79-1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71-1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000).

Conclusion: This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when used in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Keywords: Acute coronary syndromes; aetiology; cardiology; cardiovascular pharmacology; treatment.