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2 drugs equally effective for heart patients undergoing angioplasty, Mayo study finds
September 11, 2007ROCHESTER, Minn. -- In lifesaving procedures to open blocked heart arteries a key question has persisted for years: Is use of the more expensive drug, abciximab, justified over use of the less-expensive eptifibatide"
A new Mayo Clinic study to be published in the current edition of Value in Health, Volume 11, Issue 4 and now available as an e-publication, offers clinicians the first large-scale contemporary study to help answer the question. The study found no significant difference between the drugs in the length of hospital stay or in the rate of cardiovascular event rates.
"Our results provide data to show using the lower cost drug does not jeopardize patient health in contemporary percutaneous coronary intervention practice," explains the study's lead author, Kirsten Hall Long, Ph.D. Percutaneous coronary intervention (PCI), also known as angioplasty, is a procedure in which a balloon-tipped catheter is inserted into the narrowed vessel. The balloon is inflated and improves blood flow.
Researchers reviewed records of all Mayo Clinic patients who underwent PCI from November 2000 to August 2004. Of these, 2,123 patients received eptifibatide, and 951 received abciximab.
"It is not likely that there will ever be a randomized clinical trial comparing the two drugs, as it would require over 30,000 patients," says Henry Ting, M.D., Mayo Clinic cardiologist and co-author. "Our study fills an evidence gap by providing data to help guide treatment decisions."
Value in Health is a multidisciplinary peer-reviewed journal reporting on evaluations of medical technologies including pharmaceuticals, biologics, devices, procedures and other health care interventions. It provides a scientific forum for communicating health economics and outcomes research methods and findings. The journal is a publication of the International Society for Pharmacoeconomics and Outcomes Research.
Mayo Clinic
Researchers reviewed records of all Mayo Clinic patients who underwent PCI from November 2000 to August 2004. Of these, 2,123 patients received eptifibatide, and 951 received abciximab.
"It is not likely that there will ever be a randomized clinical trial comparing the two drugs, as it would require over 30,000 patients," says Henry Ting, M.D., Mayo Clinic cardiologist and co-author. "Our study fills an evidence gap by providing data to help guide treatment decisions."
Value in Health is a multidisciplinary peer-reviewed journal reporting on evaluations of medical technologies including pharmaceuticals, biologics, devices, procedures and other health care interventions. It provides a scientific forum for communicating health economics and outcomes research methods and findings. The journal is a publication of the International Society for Pharmacoeconomics and Outcomes Research.
Mayo Clinic
Abciximab Current Events and Abciximab News RSSComparison of anticoagulants for angioplasty show similar outcomes
In a comparison of anticoagulants and stents for use with angioplasty following a heart attack, the anticoagulants abciximab and tirofiban had similar outcomes for some cardiac measures within 90 minutes after the procedure, while patients who received stents that released the drug sirolimus had a lower risk of major adverse cardiac events within 8 months than patients who received uncoated stents.
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Post-stent maintenance therapies questioned
Patients admitted to the hospital with an acute coronary syndrome (ACS) are often treated with a catheter-based procedure known as percutaneous coronary intervention, or PCI. But doctors are unclear about the optimal antithrombotic therapy to prescribe after procedure to prevent clotting.
ESC Congress 2004: Dutch "ICTUS" study shows no benefit from early PCI/CABG in high risk unstable angina patients
Patients with chest pain are recognized as being at high risk of subsequent adverse cardiac events when their plasma levels of cardiac troponin are elevated as evidence of myocardial damage. Based on earlier studies, ESC and ACC/AHA guidelines recommend early angiography and PCI or CABG (early invasive strategy) in all these high risk patients. Dutch clinical investigators will present data during the Hotline II session on Sunday afternoon, August 29th, showing that modern medical treatment, and angiography followed by PCI or CABG in selected patients (selective invasive strategy), may be equally effective.
ANGIOPLASTY OR MEDICAL THERAPY IMMEDIATELY AFTER HEART ATTACK? (p 814, 825 )
Authors of a study in this week’s issue of THE LANCET suggest that there is no difference in treatment outcome of pre-hospital medical therapy with anti-clotting drugs or emergency angioplasty after severe heart attack. Although the use of anti-clotting drugs before hospital admission (prehospital fibrinolysis) and primary angioplasty (widening of the coronary arteries with balloon inflation) provide a clinical benefit over the use of anti-clotting drugs given to patients in hospital, these two strategies for the treatment of severe heart attack have not been directly compared. Eric Bonnefoy and colleagues from University Hospital, Lyon, France, did a randomised multicentre trial of
Long-term Effects Of Tirofiban Similar To Those Of Abciximab In Patients Undergoing Coronary-artery Angioplasty (p 355)
A follow-up study in this week's issue of THE LANCET helps to clarify the differences between two similar drugs in terms of their benefits for patients who undergo angioplasty for narrowed coronary arteries (the arteries that supply the heart with blood). Platelet glycoprotein IIb/IIIa inhibitors reduce the clumping together of platelets in the blood, which can lead to complications during procedures to open narrowed arteries. Tirofiban and abciximab are two such drugs, but each blocks platelet clumping in a slightly different way. Researchers around the world are trying to work out the relevance of these differences with respect to patients' health. Last year, the TARGET investigators showe
New Combination Therapy Could Reduce Ischaemia After Heart Attack (p 605)
Encouraging results from a fast-track study published in this week's issue of THE LANCET suggest a new therapeutic strategy for reducing ischaemic complications (coronary artery blockage) after heart attack. The treatment of acute heart attack requires combination of several therapies. Fibrinolytic agents given together with aspirin and unfractionated heparin often fail to restore coronary artery bloodflow. Frans Van de Werf and colleagues from Gasthuisberg University, Leuven, Belgium, did an exploratory trial to identify whether specific combinations with newer antithrombotic agents might provide clinical benefit. The aim of the study was to compare the efficacy and safety of three antithro
NO BENEFIT FROM USE OF ABCIXIMAB FOR TREATMENT OF ACUTE CORONARY SYNDROMES (pp 1899, 1915)
Results of the GUSTO IV study - published in this week's issue of THE LANCET - unexpectedly suggest that the glycoprotein IIb/IIIa inhibitor abciximab is not an appropriate treatment for patients with acute coronary syndromes (ACS) who are not undergoing revascularisation therapy. Glycoprotein IIb/IIIa blockers reduce procedure-related thrombotic complications of percutaneous coronary intervention, and the risk of death and myocardial infarction (heart attack) in patients with ACS. Maarten Simoons from University Hospital, Rotterdam, Netherlands, and colleagues did a randomised, multicentre trial to study the effect of the glycoprotein IIb/IIIa blocker abciximab on patients with ACS who were
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