BRIEF-PCI

1. Brief Infusion of Eptifibatide
Following Percutaneous Coronary
Intervention (BRIEF-PCI)
J Am Cardiology
March 2009

2. The Goal
• The goal of this trial was to evaluate a brief
infusion of eptifibatide compared with an 18-
hour infusion after elective coronary
intervention.

3. Hypothesis
• An abbreviated duration of eptifibatide would
result in a similar frequency of periprocedural
myonecrosis.

4. Drugs/Procedures Used
• Patients with stable and unstable coronary
artery disease undergoing stenting were
eligible for study participation immediately
after successful PCI.
• Patients were randomized to abbreviated
eptifibatide infusion (<2 hours) (n = 312) .
• versus standard 18-hour infusion (n = 312).

5. Concomitant Medications
• At enrollment, the use of aspirin was 100%,
adequate clopidogrel pretreatment was 71%,
angiotensin-converting enzyme inhibitor or
angiotensin-receptor blocker was 67%, beta-
blocker was 84%, and statin was 80%.

6. Exclusions:
• Age <18 years
• Recent ST-elevation myocardial infarction (<48
hours)
• Visible thrombus
• Use of bivalirudin
• Unprotected left main intervention
• Use of adjunctive devices such as ablative or
thrombectomy
• Allergy to aspirin, thienopyridine, or eptifibatide
• Unsatisfactory PCI results

7. • In the catheterization laboratory, clopidogrel
was loaded (300-600 mg) unless patients had
chronically been treated with this medication.
Heparin was administered to achieve an
activated clotting time of 200-300 seconds.
Enoxaparin could also be used according to
operator discretion. Eptifibatide was given
intravenously as a double bolus (180 µg/kg)
10 minutes apart, followed by infusion of 2
µg/kg/min.

8. Principal Findings
• verall, 624 patients were randomized. There was
no difference in baseline characteristics between
the groups. The mean age was 62 years, 20%
were women, 12% had diabetes, and the mean
body mass index was 28 kg/m2. The clinical
presentation was stable angina in 47%, acute
coronary syndrome in 39% (80% with elevated
biomarkers), and ST-elevation >48 hours in 15%.

9. • The duration of eptifibatide was 1.4 hours in
the brief infusion group versus 16.8 hours in
the standard infusion group. The mean
number of vessels treated were (1.2 vs. 1.2),
total stent length was (29.4 mm vs. 28.6 mm),
and the proportion of drug-eluting stent use
was (31.9% vs. 35.4%), respectively.

10. Primary Endpoints
• The incidence of the primary outcome,
troponin I elevation >0.26 µg/L, was 30.1% in
the brief infusion group versus 28.3% in the
standard infusion group (p < 0.012 for
noninferiority). There was no significant
interaction among any of the tested
subgroups (diabetes, acute coronary
syndrome presentation, and adequate
clopidogrel pretreatment).

11. • Death, myocardial infarction, or target vessel
revascularization was similar between the
groups (4.8% vs. 4.5%, p = NS).

12. • Major bleeding was reduced in the brief
infusion group (1.0% vs. 4.2%, p = 0.02).

13. Interpretation
• Among patients undergoing successful
coronary stenting and adequately pretreated
with clopidogrel, a brief infusion of
eptifibatide (<2 hours) was not inferior to
standard infusion (18 hours) in regard to
cardiac enzyme elevation. Composite cardiac
outcomes were similar between the groups,
although major bleeding was reduced with a
brief infusion of eptifibatide.

14. • The studied patient population mainly
consisted of stable angina.
• Although a significant proportion was acute
coronary syndrome and recent ST-elevation
myocardial infarction.
• These results do not apply to unsuccessful or
complicated PCI where a standard infusion of
eptifibatide might still be beneficial.

15. • This trial should be placed in the context of
the ISAR-REACT trial, which showed that a
glycoprotein IIb/IIIa inhibitor (abciximab) is
not beneficial in elective coronary
intervention among patients loaded with
clopidogrel.

16. • This trial enrolled a significant proportion of
acute coronary syndrome and recent ST-
elevation myocardial infarction patients.
Although the use of a glycoprotein IIb/IIIa
inhibitor might be beneficial in the former
group of patients, revascularization in general
for the latter group is controversial..

17. • Abbreviated infusion of a glycoprotein IIb/IIIa
inhibitor in acute coronary syndrome patients
will need to be specifically addressed in an
adequately powered trial.