Intracoronary bolus administration of eptifibatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina
- 99 Downloads
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.
Intracoronary eptifibatide administration during PCI for UA/NSTEMI is feasible and safe.
KeywordsNon ST elevation myocardial infarction Unstable angina Glycoprotein IIb/IIIa receptor inhibitor Intracoronary
Unable to display preview. Download preview PDF.
- 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.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.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.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
- 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.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
- 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.Mitchel JF, Alberghini TV (1996) Site-specific thrombolysis with reopro. Circulation 94:I202Google Scholar
- 13.Mitchel JF, Alberghini TV (1996) Local delivery of reopro: pharmacokinetics and effect on platelet deposition following balloon angioplasty. Circulation 94:I202Google Scholar
- 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
- 18.Physicians’ Desk Reference (2005). 59th Edition. Montvale, NJ, Medical Economics Company, pp. 2203–2207Google Scholar