Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: A 30-day follow-up study

• Published in: Catheterization and cardiovascular interventions 2002-12, Vol.57 (4), p.497-503
• Main Authors: Kaul, Upendra, Gupta, Ripen K., Haridas, Kottaram K., Ramesh, Saligrama S., Sethi, Kamal K., Singh, Balbir, Agarwal, Rajiv, Yadave, Ram D., Ghose, Tapan, Sapra, Rakesh R., Bajaj, Rajiv, Shahi, Madhukar, Bhagwat, Ajit, Kumar, Pramod, Mathews, Omen P., Soni, Pratik K.
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Blood. Blood coagulation. Reticuloendothelial system; Coronary Angiography; Dose-Response Relationship, Drug; Drug Administration Schedule; eptifibatide; Feasibility Studies; Female; Follow-Up Studies; GP IIb/IIIa inhibitors; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - drug therapy; Myocardial Infarction - surgery; Outcome Assessment (Health Care); Peptides - administration & dosage; Peptides - therapeutic use; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex - drug effects; primary stenting; Prospective Studies; Stents; Time Factors; Vascular Patency - drug effects
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.10351

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost‐effective, small‐molecule GP IIb/IIIa blocker with a shorter half‐life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 μg/kg 10 min apart and a 24‐hr infusion of 2 μg/kg/min). Clinical outcomes were evaluated at 30 days after the procedure. The angiographic patency of the vessel with TIMI flow rates, TIMI myocardial perfusion (TMP) grade, and corrected TIMI frame counts were assessed at the end of procedure and before hospital discharge. At 30 days, the primary endpoint, a composite of death, myocardial infarction, and urgent target vessel revascularization (TVR) was seen in 12.7% of patients. The TIMI 3 and TMP grade 3 flow, which was seen in 93% and 86% of patient, respectively, at the end of the procedure, declined to 86% and 78%, respectively (P < 0.05) before hospital discharge. Corrected TIMI frame counts also decreased from 25.7 ± 7.2 to 22.9 ± 6.8 (P < 0.05). There were five (9.1%) instances of subacute thrombosis (SAT) presenting as AMI, needing urgent TVR in all, within 3–5 days of the primary procedure. No excessive bleeding complication, directly attributable to the use of eptifibatide, was observed. The study was terminated prematurely because of an unacceptable SAT rate. Administration of eptifibatide along with primary stenting for AMI is associated with a high TIMI 3 and TMP grade 3 flow acutely. However, these flows decline significantly before hospital discharge and lead to a high rate of SAT. The dosage and duration of infusion of eptifibatide in this setting needs further evaluation. Cathet Cardiovasc Intervent 2002;57:497–503. © 2002 Wiley‐Liss, Inc.