Prehospital therapy with the platelet glycoprotein IIb/IIIa inhibitor eptifibatide in patients with suspected acute coronary syndromes: the Bochum feasibility study.
OBJECTIVE
To assess the practical application and safety of prehospital antithrombotic therapy with the glycoprotein (GP) IIb/IIIa inhibitor eptifibatide for patients with suspected acute coronary syndrome (ACS) or myocardial infarction (MI).


METHODS
Open-labeled pilot study. Patients with typical chest pain who were seen within 6 h of the onset of symptoms were enrolled in the mobile emergency ambulance. Patients were stratified by even/uneven days to receive standard treatment or standard treatment plus an IV bolus of eptifibatide (180 microg/kg body weight) followed by a continuous eptifibatide infusion (2 microg/kg/min). The main outcome measurement was a combination of prehospital or in-hospital death, reinfarction, revascularization of target vessels, and major bleeding complications.


RESULTS
A total of 356 patients (age range, 29 to 75 years; women, 24.7%) were included in the analysis. On admission to the hospital, the diagnosis of ACS or MI was confirmed in approximately 60% of patients, and alternative diagnoses were made in 40% of patients. The rates of complications, including fatal and nonfatal complications occurring during transportation and during subsequent hospitalization, were similar in both study groups. The primary end point occurred in 11.8% of patients in the control group, and in 9.6% of those in the eptifibatide group (difference not significant).


CONCLUSIONS
The prehospital administration of the GP IIb/IIIa inhibitor eptifibatide is feasible and safe in patients with clinically suspected ACS and MI. The benefit of this treatment has yet to be established in a large-scale multicenter study.
Hanefeld
Christoph
C
Medical Clinic II (Cardiology & Angiology), St. Josef-Hospital/Berufsgenossenschaftliche Kliniken Bergmannsheil, University Hospitals of the Ruhr-University, Gudrunstrasse 56, D-44791 Bochum, Germany.
Sirtl
Clemens
C
Spiecker
Martin
M
Bojara
Waldemar
W
Grewe
Peter H
PH
Lawo
Thomas
T
Mügge
Andreas
A
D000368:Aged; D000552:Ambulances; D001604:Berlin; D003328:Coronary Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D004632:Emergency Medical Services; D000077542:Eptifibatide; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D017063:Outcome Assessment, Health Care; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016019:Survival Analysis
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide