Intracoronary Eptifibatide During Primary Percutaneous Coronary Intervention in Early Versus Late Presenters with ST Segment Elevation Myocardial Infarction: A Randomized Trial

Authors

Ayman Elbadawi, Rochester Regional HealthFollow
Gerald Gasioch, Rochester Regional HealthFollow
Islam Y. Elgendy, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
Ahmed N. Mahmoud, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
Le Dung Ha, Rochester Regional HealthFollow
Haitham Al Ashry, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Hend Shahin, Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt.
Mohamed A. Hamza, Department of Cardiovascular Medicine, Ain Shams Medical School, Cairo, Egypt.
Ahmed S. Abuzaid, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE, USA.
Marwan Saad, Department of Cardiovascular Medicine, Ain Shams Medical School, Cairo, Egypt.

Department

Internal Medicine

Document Type

Article

Publication Title

Cardiology and Therapy

Abstract

INTRODUCTION: The role of intracoronary (IC) eptifibatide in primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI) and whether time of patient presentation affects this role are unclear. We sought to evaluate the benefit of IC eptifibatide use during primary PCI in early STEMI presenters compared to late STEMI presenters. METHODS: We included 70 patients who presented with STEMI and were eligible for PPCI. On the basis of symptom-to-door time, patients were classified into two arms: early (< 3 h, n = 34) vs late (≥ 3 h, n = 36) presenters. They were then randomized to local IC eptifibatide infusion vs standard care (control group). The primary end point was post-PCI myocardial blush grade (MBG) in the culprit vessel. Other end points included corrected TIMI frame count (cTFC), ST segment resolution (STR) ≥70%, and peak CKMB. RESULTS: In the early presenters arm, no difference was observed in MBG results ≥2 in the IC eptifibatide and control groups (100% vs 82%; p = 0.23). In the late presenters arm, the eptifibatide subgroup was associated with improved MBG ≥2 (100% vs 50%; p = 0.001). IC eptifibatide in both early and late presenters was associated with less cTFC (early presenters 19 vs. 25.6, p = 0.001; late presenters 20 vs. 31.5, p < 0.001) and less peak CKMB (early presenters 210 vs 260 IU/L, p = 0.006; late presenters 228 vs 318 IU/L, p = 0.005) compared with the control group. No difference existed between both groups in STR index in early and late presenters. CONCLUSION: IC eptifibatide might improve the reperfusion markers during PPCI for STEMI patients presenting after 3 h from onset of symptoms. A large randomized study is recommended to ascertain the benefits of IC eptifibatide in late presenters on clinical outcomes.

First Page

203

Last Page

213

DOI

10.1007/s40119-016-0073-3

Volume

5

Issue

2

Publication Date

12-1-2016

PubMed ID

27844422

Recommended Citation

Elbadawi, A., Gasioch, G., Elgendy, I. Y., Mahmoud, A. N., Ha, L. D., Ashry, H. A., Shahin, H., Hamza, M. A., Abuzaid, A. S., & Saad, M. (2016). Intracoronary Eptifibatide During Primary Percutaneous Coronary Intervention in Early Versus Late Presenters with ST Segment Elevation Myocardial Infarction: A Randomized Trial. Cardiology and Therapy, 5 (2), 203-213. https://doi.org/10.1007/s40119-016-0073-3