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Journal of Thrombosis and Thrombolysis

, Volume 22, Issue 1, pp 47–50 | Cite as

Intracoronary bolus administration of eptifibatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina

  • Albert J. Deibele
  • Ajay J. Kirtane
  • Duane S. Pinto
  • Michael J. Lucca
  • Cathy Neva
  • Amy Shui
  • Sabina A. Murphy
  • James E. Tcheng
  • C. Michael GibsonEmail author
Clinical Trials

Abstract

Background: Distal embolization of thrombotic debris may occur during and after percutaneous coronary intervention (PCI) for acute coronary syndromes. This may lead to impaired microvascular perfusion, myocardial infarction and increased morbidity and mortality. In vitro studies suggest that high local concentrations of a glycoprotein IIb/IIIa inhibitor may be effective in disaggregating thrombus and thereby prevent microvascular compromise. We hypothesized that intracoronary (IC) administration of eptifibatide during stent implantation for unstable angina/non ST elevation myocardial infarction (UA/NSTEMI) would be safe and would lead to an acceptable rate of normal myocardial perfusion.

Methods: In 54 patients with UA/NSTEMI, 2 boluses of 180 mcg/kg of eptifibatide each were administered via the IC route during PCI. Data were retrospectively collected and reviewed by an independent core laboratory.

Results: No adverse events including arrhythmias occurred during IC administration of eptifibatide. There were no deaths or urgent revascularizations among patients treated with IC eptifibatide. One patient (2.0%) sustained a post-procedure myocardial infarction. One patient sustained a TIMI major bleeding event due to a gastrointestinal bleed. There were no TIMI minor bleeding events. Normal post PCI TIMI Myocardial Perfusion Grade was observed in 54% of patients.

Conclusion: IC bolus administration of eptifibatide was feasible and safe among patients with UA/NSTEMI. Larger prospective and randomized studies are warranted to further explore the efficacy of this strategy.

Abbreviated Abstract

Intracoronary eptifibatide administration during PCI for UA/NSTEMI is feasible and safe.

Keywords

Non ST elevation myocardial infarction Unstable angina Glycoprotein IIb/IIIa receptor inhibitor Intracoronary 

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References

  1. 1.
    Enhanced suppression of the platelet IIb/IIIareceptor with integrilin therapy (ESPRIT) investigators (2000) Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomized placebo controlled trial. Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy. Lancet 356:2037–2044Google Scholar
  2. 2.
    Integrilin to minimise platelet aggregation and coronary thrombosis-II (IMPACT II) investigators (1997) Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Lancet 349:1422–1428Google Scholar
  3. 3.
    Evaluation of platelet IIb/IIIa inhibitor for stenting (EPISTENT) investigators (1998) Randomized placebo controlled and balloon angioplasty controlled trial to assess safety of coronary stenting with use of glycoprotein IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet 352:87–92Google Scholar
  4. 4.
    Evaluation in PTCA to improve long-term outcome with abciximab gp IIb/IIIa blockade (EPILOG) investigators (1997) Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med 336:1689–1696Google Scholar
  5. 5.
    Moser M, Bertram U, Peter K, Bode C, Ruef J. (2003) Abciximab, Eptifibatide, Tirofiban Exhibit dose-dependent potencies to dissolve platelet aggregates. J Cardiovasc Pharmacol 41:586–592PubMedCrossRefGoogle Scholar
  6. 6.
    Goto S, Tamura N, Ishida H (2004) Ability of anti-glycoprotein IIb/IIIa agents to dissolve platelet thrombi formed on a collagen surface under blood flow conditions. J Am Coll Cardiol 44:316–323PubMedCrossRefGoogle Scholar
  7. 7.
    Gibson CM, Jennings LK, Murphy SA, et al (2004) Association between platelet receptor occupancy after eptifibatide (integrilin) therapy and patency, myocardial perfusion, and ST-segment resolution among patients with ST-segment-elevation myocardial infarction. an INTEGRITI (integrilin and tenecteplase in acute myocardial infarction) substudy. Circulation 110:679–684PubMedCrossRefGoogle Scholar
  8. 8.
    Thrombolysis in Myocardial Infarction (TIMI) study group (1985) The thrombolysis in myocardial infarction (TIMI) trial. phase I findings. N Engl J Med 312:932–936Google Scholar
  9. 9.
    Gibson CM, Cannon CP, Daley WL, et al (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888PubMedGoogle Scholar
  10. 10.
    Gibson CM, Cannon CP, Murphy SA, et al (2000) Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 101:125–130PubMedGoogle Scholar
  11. 11.
    Gibson CM. (2004) A randomized trial to evaluate the relative protection against post-PCI microvascular dysfunction and post-PCI ischemia among anti-platelet and anti-thrombotic agents. New Orleans: Texas Heart Symposium.Google Scholar
  12. 12.
    Mitchel JF, Alberghini TV (1996) Site-specific thrombolysis with reopro. Circulation 94:I202Google Scholar
  13. 13.
    Mitchel JF, Alberghini TV (1996) Local delivery of reopro: pharmacokinetics and effect on platelet deposition following balloon angioplasty. Circulation 94:I202Google Scholar
  14. 14.
    Bailey SR, O’Leary E, Chilton R (1997) Angioscopic evaluation of site-specific administration of reopro. Catheter Cardiovasc Diagn 42:181–184CrossRefGoogle Scholar
  15. 15.
    Bartorelli AL, Trabattoni D, Galli S, Grancini L, Cozzi S, Ravagnani P (1999) Successful dissolution of occlusive thrombus with local administration of abciximab during PTCA. Catheter Cardiovasc Interv 48:211–213PubMedCrossRefGoogle Scholar
  16. 16.
    Wöhrle J, Grebe OC, Nusser T, et al (2003) Reduction of major adverse cardiac events with intracoronary compared with intravenous bolus application of abciximab in patients with acute myocardial infarction on unstable angina undergoing coronary angioplasty. Circulation 107:1840–1843PubMedCrossRefGoogle Scholar
  17. 17.
    Kakkar AK, Moustapha A, Hanley HG, et al. (2004) Comparison of intracoronary vs intravenous administration of abciximab in coronary stenting. Catheter Cardiovasc Interv 61:31–34PubMedCrossRefGoogle Scholar
  18. 18.
    Physicians’ Desk Reference (2005). 59th Edition. Montvale, NJ, Medical Economics Company, pp. 2203–2207Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  • Albert J. Deibele
    • 1
  • Ajay J. Kirtane
    • 2
  • Duane S. Pinto
    • 2
  • Michael J. Lucca
    • 1
  • Cathy Neva
    • 1
  • Amy Shui
    • 2
  • Sabina A. Murphy
    • 2
  • James E. Tcheng
    • 3
  • C. Michael Gibson
    • 2
    • 4
    Email author
  1. 1.Division of CardiologyDuluth ClinicDuluth
  2. 2.Division of CardiologyBeth Israel Deaconess Medical CenterBoston
  3. 3.Division of CardiologyDuke University Medical CenterDurham
  4. 4.Boston

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