An overview of the results of the EPIC trial

Abstract

The Evaluation of 7E3 for the Prevention of Ischaemic Complications (EPIC) trial assessed the use of abciximab in the treatment of patients at high risk undergoing percutaneous revascularization procedures. Abciximab (c7E3) is a chimeric monoclonal antibody targeted to block the glycoprotein IIb/IIIa receptor on the surface of the platelet; this receptor is believed to be the final common pathway of platelet aggregation. Administered at the time of angioplasty or directional coronary atherectomy, abciximab had a beneficial effect in the population studied, which included patients considered to be at high risk from complications of the procedure, based on the presence of acute or recent myocardial infarction, severe unstable angina or adverse coronary morphological characteristics. Abciximab reduced the risk of the primary endpoint at 30 days (death, myocardial infarction, repeat angioplasty or bypass surgery for recurrent ischaemia, balloon pump or stent insertion for ischaemia) by 35%: from 12.8% in the placebo group to 8.3% in patients treated with abciximab bolus and infusion. This trend was observed as a whole and in each component of the primary endpoint. At 6 months follow-up, the effect of the treatment was modestly enhanced beyond 30 days. A variety of substudies have documented substantial evidence of treatment benefit in patients with acute myocardial infarction and unstable angina. Non-fatal infarction, observed as beyond that normally expected in other studies with directional coronary atherectomy, was not above normal in patients treated with abciximab, and there was evidence of a treatment benefit in the elderly, although more information would be helpful in patients over the age of 70. The substantial site-to-site variability indicates that standardization of percutaneous revascularization could enhance the benefit of abciximab, while reducing bleeding complications.