Heart Drug Cuts Death And Heart Attack Rate By 40 Percent In Angioplasty-Stent Procedure

The drug eptifibatide (tradename Integrilin) cut deaths and heart attacks by 40 percent in the first 48 hours after it was used in patients who received a balloon angioplasty, which uses a catheter to press artery-obstructing plaque flat, and the implant of a stent, a mesh-like device that props the artery open. Eptifibatide's benefit was consistent in all groups of patients studied in the trial.

The finding is important for patients because eptifibatide is a much more affordable alternative than the only other agent in the class of drugs that has been shown to be effective in preventing clots during the procedure. That drug, abciximab (tradename Reopro), costs $1,500, compared to $400 for eptifibatide.

"Now only about 20 percent of patients being treated with a coronary stent receive platelet inhibitor therapy," said the study's principal investigator, Dr. James Tcheng, a cardiologist at the Duke Clinical Research Institute. "The main reason more patients are not being treated with these drugs is the high cost of treatment.

"Eptifibatide is a more affordable drug which we have now shown to be highly effective in coronary stenting," Tcheng said in an interview. "This could make a dramatic difference in the outcomes of patients treated with a stent angioplasty procedure."

Tcheng prepared the results of the trial, known as ESPRIT (Enhanced Suppression of the Platelet Receptor glycoprotein IIb/IIIa using Integrilin Therapy), for presentation Tuesday at the annual scientific meeting of the American College of Cardiology. ESPRIT was funded by COR Therapeutics Inc., and Schering-Plough Corp., developers of eptifibatide.

The trial was halted ahead of schedule in February because an interim analysis showed highly significant reductions in the rates of death or heart attack at both 48 hours and at 30 days. An Independent Data and Safety Monitoring Committee thought it would be unethical to continue to offer only half of patients treatment with eptifibatide when the drug had proved effective.

Nearly 600,000 coronary angioplasty procedures are performed in the United States each year to restore blood flow through blocked arteries, and more than 80 percent of these procedures use stents. But the procedure carries risks - deploying a catheter and stent can disrupt the wall of an artery, and can promote the clumping together of blood platelet cells to form blood clots.

Eptifibatide was given intravenously to patients in the trial immediately before and during an angioplasty, as well as for an average of 18 hours following the procedure. The drug is classified as a "small molecule" inhibitor and works by blocking the key glycoprotein IIb/IIIa receptor on platelets