A randomized, placebo-controlled trial of early eptifibatide for non-ST–segment elevation acute coronary syndromes

Background The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST–segment elevation acute coronary syndromes (NSTE ACS) remain unclear. Methods In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo for 12 to 24 hours before crossover to open-label eptifibatide. Serial creatine-kinase MB (CK-MB) and quantitative cardiac troponin T levels were collected during the first 24 hours to assess the impact of early platelet glycoprotein IIb/IIIa blockade on infarct size as measured by cardiac markers. Results Median peak CK-MB (10.3 vs 11.8 ng/mL; P = .71) and peak quantitative cardiac troponin T levels (0.2 vs 0.3 ng/mL; P = .95) were similar between treatment groups, respectively. Median calculated peak CK-MB values (41 vs 40 ng/mL; P = .72) and area under the CK-MB curve measurements (980 vs 764 μg/min/L; P = .68) from curve-fitting analyses that could be performed in 106 of 311 patients were also similar. Conclusions In this pilot trial, early administration of eptifibatide in the emergency department did not modulate serologic measurements of infarct size in patients with NSTE ACS.