Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial

Abstract

Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.

Effect of intra-coronary administration of tirofiban through aspiration catheter on patients over 60 years with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

“…By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the risks of short-term mortality and procedural failure. [27,28] A meta-analysis provided evidence of a net clinical benefit for intracoronary versus intravenous abciximab administration, with the highest benefit observed in high-risk ACS patients, such as those with reduced baseline left ventricular ejection fraction (LVEF). [29]…”

Comparison between Bolus Intracoronary versus Bolus Intravenous Injection Regimens of Eptifibatide during Primary Percutaneous Coronary Intervention in Patients with Anterior ST-Segment Elevation Myocardial Infarction

“…Sanati с соавт. [20] кандидаты для ПЧКВ были рандомизированы в три группы в соответствии со способом введения эптифибатида: в/в болюсная иньекция с последующей 12-часовой инфузией (в/в-в/в), и/к болюсная иньекция с последующей в/в инфузией (и/к-в/в) и только и/к болюсное введение (и/к). Исследование включало 99 пациентов.…”

“…Не было выявлено значимых различий между 3 группами в отношении смертности в стационаре и спустя 1 мес наблюдения (р=0,99), рецидива ИМ (р=0,89), частоты достижения 3 степени кровотока по TIMI после ПЧКВ (р=0,97), снижения сегмента ST (р=0,77) и пиковых уровней тропонина (р=0,82). Сравнение групп по частоте развития больших кровотечений не было возможным в связи с небольшим количеством данных осложнений [20]. По мнению авторов при изменении пути введения эптифибатида сохраняется клинический эффект без увеличения краткосрочной летальности и неудач, связанных с процедурой.…”

“…In the study of H.R. Sanati et al [20] PPCI candidates were randomized into 3 groups according to methods of administration of eptifibatide: I/V bolus injection followed by 12-hour infusion (I/V-I/V), I/C bolus injection followed by I/V infusion (I/C-I/V), and only I/C bolus injection. The study included 99 patients.…”

“…Eptifibatid in Primary PCI Эптифибатид при первичном ЧКВ (p=0.89), post-PCI TIMI flow grade 3 (p=0.97), ST segment resolution (p=0.77) and peak troponin levels (p=0.82).The comparison of vascular access and major bleeding complications were not possible due to low events rate [20]. And they concluded that by modifying the route of administration of eptifibatide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure [20].…”