Intracoronary bolus administration of eptifibatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina.
BACKGROUND
Distal embolization of thrombotic debris may occur during and after percutaneous coronary intervention (PCI) for acute coronary syndromes. This may lead to impaired microvascular perfusion, myocardial infarction and increased morbidity and mortality. In vitro studies suggest that high local concentrations of a glycoprotein IIb/IIIa inhibitor may be effective in disaggregating thrombus and thereby prevent microvascular compromise. We hypothesized that intracoronary (IC) administration of eptifibatide during stent implantation for unstable angina/non ST elevation myocardial infarction (UA/NSTEMI) would be safe and would lead to an acceptable rate of normal myocardial perfusion.


METHODS
In 54 patients with UA/NSTEMI, 2 boluses of 180 mcg/kg of eptifibatide each were administered via the IC route during PCI. Data were retrospectively collected and reviewed by an independent core laboratory.


RESULTS
No adverse events including arrhythmias occurred during IC administration of eptifibatide. There were no deaths or urgent revascularizations among patients treated with IC eptifibatide. One patient (2.0%) sustained a post-procedure myocardial infarction. One patient sustained a TIMI major bleeding event due to a gastrointestinal bleed. There were no TIMI minor bleeding events. Normal post PCI TIMI Myocardial Perfusion Grade was observed in 54% of patients.


CONCLUSIONS
IC bolus administration of eptifibatide was feasible and safe among patients with UA/NSTEMI. Larger prospective and randomized studies are warranted to further explore the efficacy of this strategy. Intracoronary eptifibatide administration during PCI for UA/NSTEMI is feasible and safe.
Deibele
Albert J
AJ
Division of Cardiology, Duluth Clinic, Duluth, Minnesota, USA.
Kirtane
Ajay J
AJ
Pinto
Duane S
DS
Lucca
Michael J
MJ
Neva
Cathy
C
Shui
Amy
A
Murphy
Sabina A
SA
Tcheng
James E
JE
Gibson
C Michael
CM
D000368:Aged; D000789:Angina, Unstable / Q000601:surgery; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography; D000077542:Eptifibatide; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D015425:Myocardial Reperfusion / Q000379:methods; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013923:Thromboembolism / Q000517:prevention & control*
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide