Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial.
BACKGROUND
Early restoration of epicardial flow before primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been associated with improved clinical outcomes.


METHODS
We hypothesized that early administration of the glycoprotein IIb/IIIa inhibitor eptifibatide in the emergency department (ED) would yield superior epicardial flow and myocardial perfusion before primary PCI compared with initiating eptifibatide after diagnostic angiography in the cardiac catheterization laboratory (CCL). Three hundred forty-three patients with STEMI were randomized to either early ED eptifibatide (n = 180) or CCL eptifibatide (n = 163).


RESULTS
The primary end point (pre-PCI corrected TIMI frame count) was significantly lower (faster flow) with early eptifibatide (77.5 +/- 32.2 vs 84.3 +/- 30.7, P = .049). The incidence of normal pre-PCI TIMI myocardial perfusion was increased among patients treated in the ED versus CCL (24% vs 14%, P = .026). There was no excess of TIMI major or minor bleeding among patients treated in the ED versus CCL (6.9% [12/174] vs 7.8% [11/142], P = NS).


CONCLUSIONS
A strategy of early initiation of eptifibatide in the ED before primary PCI for STEMI yields superior pre-PCI TIMI frame counts, reflecting epicardial flow, and superior TIMI myocardial perfusion compared with a strategy of initiating eptifibatide in the CCL without an increase in bleeding risk.
Gibson
C Michael
CM
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and the Department of Medicine, Harvard Medical School, Boston, MA, USA. mgibson@timi.org
Kirtane
Ajay J
AJ
Murphy
Sabina A
SA
Rohrbeck
Steve
S
Menon
Venu
V
Lins
Jeffrey
J
Kazziha
Samer
S
Rokos
Ivan
I
Shammas
Nicolas W
NW
Palabrica
Theresa M
TM
Fish
Polly
P
McCabe
Carolyn H
CH
Braunwald
Eugene
E
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy; D004334:Drug Administration Schedule; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D000077542:Eptifibatide; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010455:Peptides / Q000008:administration & dosage* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012008:Recurrence; D012720:Severity of Illness Index; D013577:Syndrome
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide