The EVA-AMI trial compared two intravenous glycoprotein IIb/IIIa inhibitors (GPI), eptifibatide and abciximab, as adjuncts to primary percutaneous coronary intervention (PCI) with respect to several measures of myocardial perfusion. The study represents the first head-to-head comparison of two GPIs in primary PCI for ST-elevation myocardial infarction (STEMI).

EVA-AMI involved 430 STEMI patients with fewer than 12 hours of symptoms and who were scheduled for primary PCI. The patients were randomly assigned to either eptifibatide (double bolus followed by 24-hour infusion; 226 patients) or abciximab (bolus followed by 12-hour infusion; 201 patients). All patients received aspirin, clopidogrel, and unfractionated heparin or enoxaparin.

The primary endpoint was ST resolution at 1 hour after PCI. ST resolution is a marker of myocardial perfusion and has been closely linked to short- and long-term mortality after STEMI, thus making it an ideal surrogate endpoint for comparing adjunctive therapies in reperfusion. Electrocardiograms were performed at baseline and 1 hour after PCI; ST resolution of more than 70% was considered to be complete, and resolution between 30% and 70% was considered to be partial.

Myocardial perfusion, as assessed by TIMI flow grade after PCI, did not differ significantly between eptifibatide and abciximab (82.4% vs 84.3%). Electrocardiographic data after PCI were available for 220 patients. The rates of complete ST resolution between the two groups were similar (63.1% for the eptifibatide group and 59.6% for the abciximab group) and met the criteria for noninferiority (Table 1). However, significantly more patients in the abciximab group had no ST resolution (14.7% vs 5.4%; p=0.021). With regard to in-hospital clinical events, the two GPIs did not differ significantly with respect to rates of death, myocardial infarction, heart failure, target vessel revascularization, or minor or major bleeding (Table 1).

Uwe Zeymer, MD, Herzzentrum Ludwigshafen, Germany, who reported the findings of the study, noted that processing of the study data has not been completed. The study's clinical events committee has not yet evaluated the clinical events and serious adverse events, and collection of 6-month follow-up data is still ongoing.

“Because eptifibatide is less expensive than abciximab, it may be a valid alternative to abciximab for patients with STEMI undergoing primary PCI,” said Dr. Zeymer.