Microvascular Effect of Intracoronary Eptifibatide in Acute Myocardial Infarction

Abstract

Objectives: In this prospective, randomized trial in patients with acute myocardial infarction (AMI) admitted for primary percutaneous coronary intervention (PPCI), loaded with 600 mg clopidogrel, we hypothesized that eptifibatide administered downstream of the coronary occlusion leads to a lower degree of microvascular obstruction compared with no additional eptifibatide. Methods: Fifty patients with AMI, loaded with 600 mg of clopidogrel at the first hospital contact, with occlusion of the left anterior descending artery (LAD), were randomized to an eptifibatide group (EG) or a control group (CG). In both groups, stenting was performed after thrombus aspiration. Microvascular reperfusion was assessed by angiography, electrocardiography, and transthoracic Doppler ultrasonography of the LAD. Results: TIMI myocardial perfusion grade 2–3 was not different between the EG (72%) and the CG (84%) (p = 0.31). ST segment resolution >70% was similarly detected in both groups (32 vs. 40%; p = 0.56). The mean diastolic deceleration time did not differ significantly between the CG (856.36 ± 397.88 ms) and the EG (935.72 ± 252.22 ms) (p = 0.41). Multivariate logistic regression revealed no significant influence of the treatment with eptifibatide on ST segment resolution (OR 0.47; 95% CI 0.11–2.10, p = 0.32), TIMI myocardial perfusion (OR 0.52; 95% CI 0.10–2.59, p = 0.42), and diastolic deceleration time (OR 0.21; 95% CI 0.03–1.51, p = 0.12). Conclusions: In AMI patients loaded with 600 mg of clopidogrel undergoing PPCI, intracoronary administration of eptifibatide does not clearly improve microvascular obstruction.

In ST‐segment elevation myocardial infarction, the echocardiographic parameters of microvascular obstruction are not associated with left ventricular remodeling at five years of follow‐up

“…Coronary wedge pressure was measured through microcatheters (Vascular Solutions, Minneapolis, Minn., USA) and was immediately followed by downstream eptifibatide administration. The drug was administered after a previously mentioned protocol, in order to achieve high drug concentrations . Primary percutaneous coronary intervention (PCI) was performed using manual thrombus aspiration (Export Aspiration Catheter; Medtronic, Inc., Minneapolis, Minn., USA) followed by direct stent implantation.…”

Serial transthoracic coronary Doppler shows complete reversibility of microvascular obstruction pattern at one month after reperfused acute myocardial infarction.

“…All patients signed an informed consent before the index pPCI. This was an exploratory research, conducted before the randomised phase of our previously published work [18], following the same examination protocols. The diagnosis and treatment of STEMI were made according to the current practice guidelines at the time of the study [19], as decided by the attending physician.…”

Intracoronary GP IIb/IIIa Inhibitors: Could Eptifibatide Be the New Kid on the Block?

“…Such a trial is published in this issue of Cardiology, where Iancu et al [7] present data from a small (n = 50) single blinded, randomized trial comparing IC eptifibatide to no GP IIb/IIIa inhibitors on top of 600 mg clopidogrel and followed by thrombus aspiration in LAD culprit STEMI patients treated with primary PCI. They defined their primary end points focused on surrogate parameters of microvascular obstruction (MVO) and infarct size.…”

“…Iancu et al [7] used eptifibatide in their study. The obvious reason for this is the lower price compared to, for example, abciximab.…”

“…Despite the negative result, Iancu et al [7] should be congratulated on a well-executed trial. Especially the use of super selective delivery of eptifibatide is to be emphasized.…”