Microvascular effect of intracoronary eptifibatide in acute myocardial infarction.

Abstract

OBJECTIVES:

In this prospective, randomized trial in patients with acute myocardial infarction (AMI) admitted for primary percutaneous coronary intervention (PPCI), loaded with 600 mg clopidogrel, we hypothesized that eptifibatide administered downstream of the coronary occlusion leads to a lower degree of microvascular obstruction compared with no additional eptifibatide.

METHODS:

Fifty patients with AMI, loaded with 600 mg of clopidogrel at the first hospital contact, with occlusion of the left anterior descending artery (LAD), were randomized to an eptifibatide group (EG) or a control group (CG). In both groups, stenting was performed after thrombus aspiration. Microvascular reperfusion was assessed by angiography, electrocardiography, and transthoracic Doppler ultrasonography of the LAD.

RESULTS:

TIMI myocardial perfusion grade 2-3 was not different between the EG (72%) and the CG (84%) (p = 0.31). ST segment resolution >70% was similarly detected in both groups (32 vs. 40%; p = 0.56). The mean diastolic deceleration time did not differ significantly between the CG (856.36 ± 397.88 ms) and the EG (935.72 ± 252.22 ms) (p = 0.41). Multivariate logistic regression revealed no significant influence of the treatment with eptifibatide on ST segment resolution (OR 0.47; 95% CI 0.11-2.10, p = 0.32), TIMI myocardial perfusion (OR 0.52; 95% CI 0.10-2.59, p = 0.42), and diastolic deceleration time (OR 0.21; 95% CI 0.03-1.51, p = 0.12).

CONCLUSIONS:

In AMI patients loaded with 600 mg of clopidogrel undergoing PPCI, intracoronary administration of eptifibatide does not clearly improve microvascular obstruction.

• Authors: Adrian Iancu, Camelia Ober, Cosmina Ioana Bondor, Horaţiu Cadiş
• Journal: Cardiology (Cardiology) Vol. 123 Issue 1 Pg. 46-53 ( 2012) ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 22986471 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 S. Karger AG, Basel.

Chemical References

• Peptides
• Platelet Aggregation Inhibitors
• Clopidogrel
• Eptifibatide
• Ticlopidine

Topics

• Adolescent
• Adult
• Clopidogrel
• Coronary Angiography
• Echocardiography
• Electrocardiography
• Eptifibatide
• Female
• Humans
• Male
• Microcirculation
• Middle Aged
• Myocardial Infarction (drug therapy)
• Myocardial Reperfusion (methods)
• Peptides (administration & dosage)
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors (administration & dosage)
• Prospective Studies
• Thrombosis (therapy)
• Ticlopidine (analogs & derivatives, therapeutic use)
• Treatment Outcome
• Young Adult