title: Intracoronary Eptifibatide During Primary Percutaneous Coronary Intervention in Early Versus Late Presenters with ST Segment Elevation Myocardial Infarction: A Randomized Trial.
abstract: BACKGROUND
  The role of intracoronary (IC) eptifibatide in primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI) and whether time of patient presentation affects this role are unclear. We sought to evaluate the benefit of IC eptifibatide use during primary PCI in early STEMI presenters compared to late STEMI presenters.
  
  
  METHODS
  We included 70 patients who presented with STEMI and were eligible for PPCI. On the basis of symptom-to-door time, patients were classified into two arms: early (<3 h, n = 34) vs late (≥3 h, n = 36) presenters. They were then randomized to local IC eptifibatide infusion vs standard care (control group). The primary end point was post-PCI myocardial blush grade (MBG) in the culprit vessel. Other end points included corrected TIMI frame count (cTFC), ST segment resolution (STR) ≥70%, and peak CKMB.
  
  
  RESULTS
  In the early presenters arm, no difference was observed in MBG results ≥2 in the IC eptifibatide and control groups (100% vs 82%; p = 0.23). In the late presenters arm, the eptifibatide subgroup was associated with improved MBG ≥2 (100% vs 50%; p = 0.001). IC eptifibatide in both early and late presenters was associated with less cTFC (early presenters 19 vs. 25.6, p = 0.001; late presenters 20 vs. 31.5, p < 0.001) and less peak CKMB (early presenters 210 vs 260 IU/L, p = 0.006; late presenters 228 vs 318 IU/L, p = 0.005) compared with the control group. No difference existed between both groups in STR index in early and late presenters.
  
  
  CONCLUSIONS
  IC eptifibatide might improve the reperfusion markers during PPCI for STEMI patients presenting after 3 h from onset of symptoms. A large randomized study is recommended to ascertain the benefits of IC eptifibatide in late presenters on clinical outcomes.
authors.affiliation: Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.|Department of Cardiovascular Medicine, Ain Shams Medical School, Cairo, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: Elbadawi
authors.affiliation: Department of Cardiovascular Medicine, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gasioch
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA. Islam.elgendy@medicine.ufl.edu.
authors.forename: Islam Y
authors.identifier: http://orcid.org/0000-0001-9853-7591
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
authors.affiliation: Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Le Dung
authors.initials: LD
authors.lastname: Ha
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Haitham Al
authors.initials: HA
authors.lastname: Ashry
authors.affiliation: Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, Cairo, Egypt.
authors.forename: Hend
authors.initials: H
authors.lastname: Shahin
authors.affiliation: Department of Cardiovascular Medicine, Ain Shams Medical School, Cairo, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Hamza
authors.affiliation: Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE, USA.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Abuzaid
authors.affiliation: Department of Cardiovascular Medicine, Ain Shams Medical School, Cairo, Egypt.|Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Marwan
authors.initials: M
authors.lastname: Saad
keywords: Intracoronary eptifibatide; Percutaneous coronary intervention; ST segment elevation myocardial infarction