Document Type : Original Article(s)
Interventional Cardiology Fellowship, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Assistant Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Previous studies have proved that intracoronary injection of eptifibatide is safe and more effective in infarct size reduction and clinical outcomes than intravenously injection in the patients with acute myocardial infarction (AMI). This study aimed to compare the effect of localized and intracoronary injection of eptifibatide on myocardial perfusion improvement and its outcomes.METHODS: We conducted a randomized clinical trial study of 60 patients presented with thrombotic AMI. The patients underwent percutaneous coronary intervention (PCI), and were randomly divided into two equal number groups. The first group received two bolus doses of 180 μg/kg eptifibatide through guiding catheter. The second group received the same bolus doses through export aspiration catheter into the coronary lesion directly. Thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and no-reflow phenomenon were primary end points. Secondary end points were pre- and postprocedure cardiac arrhythmia, in-hospital mortality, adverse effects, reinfection, pre-discharge ventricular systolic function, and re-hospitalization and mortality after 6 month of follow up.RESULTS: The mean ages of group I and group II were 58.3 ± 1.8 and 57.0 ±2.0 years, respectively, and most of patient were men (90% in group I and 80% in group II). Postprocedural TIMI flow grade 3 was achieved in 60.0% and 76.7% of the intracoronary and intralesional groups, respectively (P = 0.307). Postprocedural MBG grade 3 was achieved in 53.3% and 70.0% in intracoronary and intralesional groups, respectively (P = 0.479). There was no significant difference between the groups in no-reflow assessment. Moreover, no significant difference was seen between the two groups in secondary end-point analysis.CONCLUSION: Both methods of intracoronary and intralesional eptifibatide administration during primary PCI in patients with acute ST-elevation myocardial infarction (STEMI) were safe and similar in myocardial perfusion outcomes.
- Winchester DE, Wen X, Brearley WD, Park KE, Anderson RD, Bavry AA. Efficacy and safety of glycoprotein IIb/IIIa inhibitors during elective coronary revascularization: A meta-analysis of randomized trials performed in the era of stents and thienopyridines. J Am Coll Cardiol 2011; 57(10): 1190-9.
- Topol EJ, Yadav JS. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation 2000; 101(5): 570-80.
- Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1999; 34(3): 890-911.
- De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann FJ, et al. Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: A meta-analysis of randomized trials. JAMA 2005; 293(14): 1759-65.
- Kandzari DE, Hasselblad V, Tcheng JE, Stone GW, Califf RM, Kastrati A, et al. Improved clinical outcomes with abciximab therapy in acute myocardial infarction: A systematic overview of randomized clinical trials. Am Heart J 2004; 147(3): 457-62.
- Gibson CM, Zorkun C, Kunadian V. Intracoronary administration of abciximab in ST-elevation myocardial infarction. Circulation 2008; 118(1): 6-8.
- Kunichika H, Ben-Yehuda O, Lafitte S, Kunichika N, Peters B, DeMaria AN. Effects of glycoprotein IIb/IIIa inhibition on microvascular flow after coronary reperfusion. A quantitative myocardial contrast echocardiography study. J Am Coll Cardiol 2004; 43(2): 276-83.
- Sianos G, Papafaklis MI, Serruys PW. Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. J Invasive Cardiol 2010; 22(10 Suppl B): 6B-14B.
- Desch S, Siegemund A, Scholz U, Adam N, Eitel I, de Waha S, et al. Platelet inhibition and GP IIb/IIIa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction. Clin Res Cardiol 2012; 101(2): 117-24.
- Deibele AJ, Jennings LK, Tcheng JE, Neva C, Earhart AD, Gibson CM. Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial. Circulation 2010; 121(6): 784-91.
- Gu YL, Kampinga MA, Wieringa WG, Fokkema ML, Nijsten MW, Hillege HL, et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: The comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation 2010; 122(25): 2709-17.
- Hamza MA, Galal A, Suweilam S, Ismail M. Local Intracoronary Eptifibatide versus Mechanical Aspiration in Patients with Acute ST-Elevation Myocardial Infarction. Int J Vasc Med 2014; 2014: 294065.
- Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH, et al.
- Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA 2012; 307(17): 1817-26.
- Hassan W, Al-Sergani H, Al Buraiki J, Dunn B, Al Turki F, Akhras N, et al. Immediate and intermediate results of intracoronary stand-alone bolus administration of eptifibatide during coronary intervention (ICE) study. Am Heart J 2007; 154(2): 345-51.
- Dziewierz A, Brzezinski M, Rakowski T, Dudek D. Local administration of abciximab using a ClearWay RX infusion catheter in a patient with acute coronary syndrome caused by late in-stent thrombosis. Kardiol Pol 2012; 70(11): 1199-201.
- Stone GW, Witzenbichler B, Godlewski J, Dambrink JH, Ochala A, Chowdhary S, et al. Intralesional abciximab and thrombus aspiration in patients with large anterior myocardial infarction: One-year results from the INFUSE-AMI trial. Circ Cardiovasc Interv 2013; 6(5): 527-34.
- Prati F, Capodanno D, Pawlowski T, Ramazzotti V, Albertucci M, La Manna A, et al. Local delivery versus intracoronary infusion of abciximab in patients with acute coronary syndromes. JACC Cardiovasc Interv 2010; 3(9): 928-34.