[Value of eptifibatide during salvage angioplasty with coronary stenting after failure of thrombolysis. Report of a series of 41 patients].
OBJECTIVE
To evaluate the risks and the significance of the use of an anti-GPIIb/IIIa, in this case Eptifibatide, during angioplasty following presumed failure of thrombolysis in the acute phase of myocardial infarction.


METHODS
Patients thrombolyzed following MI < 6 hours. Presumed failure of reperfusion with full dose thrombolysis. Analysis evaluated the success of angioplasty associated with anti-GPIIb/IIIa treatment and the hospital phase outcome.


RESULTS
41 consecutive patients, 32 male (78%) and 9 female (22%), were included. Infarction concerned the anterior region in 22 cases (54%) and inferior in 19 cases (46%). Fibrinolysis was performed using Alteplase in 28 patients (68%) and Reteplase in 13 patients (32%). Radial access was performed in 32 cases (78%). All of the patients received Eptifibatide with a bolus then infusion from their admission to the haemodynamic suite, on average 1 h 30 after the start of thrombolytic treatment. A total of 49 stents were implanted in 41 patients. A flux of TIMI 3 was obtained in 37 patients (90.2%). TIMI 2 in 2 patients (4.9%) and no reflow in 2 patients (4.9%). Four counter-pulsions by intra-aortic balloon were necessary (9.8%) for cardiogenic shock. No decrease in TIMI flux was observed after the angioplasty procedure. The main complications were a death from cardiogenic shock in one patients (2.4%), a non-fatal digestive tract haemorrhage in 2 cases (4.9%) and a single femoral haematoma requiring transfusion.


CONCLUSIONS
The initial results were encouraging: high success rates, rare vascular complications, a probable consequence of the radial approach. The association of an anti-GPIIb/IIIa, Eptifibatide, therefore appears achievable during angioplasty with the positioning of a coronary endoprosthesis following the presumed failure of full dose thrombolysis.
Idir
M
M
Service de cardiologie, CH Pau, 64 000 Pau.
Delarche
N
N
Banos
J L
JL
Milandou
A
A
Ache Papillon
C
C
Estrade
G
G
D000328:Adult; D000368:Aged; D017130:Angioplasty; D004351:Drug Resistance; D000077542:Eptifibatide; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010455:Peptides / Q000008:administration & dosage / Q000494:pharmacology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D019919:Prosthesis Implantation; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012307:Risk Factors; D016879:Salvage Therapy; D015607:Stents; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide