Despite the availability of several potent antithrombotic agents, the optimal antiplatelet regimen in elective patients undergoing complex percutaneous coronary interventions is still debated. Aim of the INtegrilin plus STenting to Avoid myocardial Necrosis Trial will be to assess the safety and efficacy of routine usage of the glycoprotein IIb/IIIa inhibitor eptifibatide in patients already treated with aspirin and clopidogrel and undergoing implantation of at least two drug-eluting stents in the same lesion, thus identifying a clinically stable but anatomically complex patient subset.
This will be a single-blind, placebo-controlled multicenter randomized trial.
Patients with stable coronary artery disease, who are undergoing percutaneous coronary intervention by means of implantation of greater than 33 mm of drug-eluting stents (e.g. with two 23-mm drug-eluting stents or one 32-mm and one 12-mm drug-eluting stent), will be randomized, after administration of aspirin and clopidogrel (600 mg loading dose recommended), to eptifibatide and unfractioned heparin according to the ESPRIT protocol or placebo and unfractioned heparin. Blood draws for creatine kinase-MB mass, total creatine kinase, and cardiac troponin levels will be taken at baseline, 6 and 12 h postprocedurally. Patients will be followed for clinical events by direct visit or phone contact up to 6 months. The primary endpoint of the study will be the rate of abnormal values of creatine kinase-MB mass after percutaneous coronary intervention. Secondary endpoints will be the composite of cardiac death, nonfatal myocardial infarction, urgent target vessel revascularization, and thrombotic bailout glycoprotein IIb/IIIa inhibitor therapy within 180 days, and in-hospital, 1-month and 6-month major adverse cardiovascular events, defined as the composite of cardiac death, nonfatal myocardial infarction or urgent target vessel revascularization.
The INtegrilin plus STenting to Avoid myocardial Necrosis Trial study will test for the first time the beneficial impact of routine glycoprotein IIb/IIIa inhibition on top of dual oral antiplatelet treatment in clinically stable yet anatomically complex patients undergoing drug-eluting stents implantation. Results of this single-blind randomized trial will provide important insights to improve the management strategy of patients and outcomes in the current drug-eluting stents era.
aInterventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy
bInstitute of Cardiology, University of Ferrara, Ferrara, Italy
cCardiovascular Research Center, Salvatore Maugeri Foundation, IRCCS, Gussago, Italy
dDivision of Cardiology II, Careggi Hospital, Florence, Italy
eInstitute of Cardiology, Sant'Orsola Hospital, Bologna, Italy
fInstitute of Cardiology, San Giovanni Hospital, Rome, Italy
gInstitite of Cardiology, San Martino Hospital, Genoa, Italy
hCardiology Department, Carlo Poma Hospital, Mantova, Italy
iDivision of Cardiology, San Camillo Hospital, Rome, Italy
jDepartment of Cardiovascular Sciences University ‘La Sapienza’, Rome, Italy
kUnit of Interventional Cardiology, ARNAS, Palermo, Italy
lInstitute of Cardiology, Tor Vergata University, Rome, Italy
mInterventional Cardiology Unit, San Raffaele Hospital, Italy
nEMO Centro Cuore Columbus, Milan, Italy
Correspondence to Dr Giuseppe M. Sangiorgi, Emo Centro Cuore Columbus, Via Buonarroti 48-20145 Milan, Italy Fax: +39 02 48193433; e-mail: firstname.lastname@example.org