Download PDF
Int J Angiol 2014; 23(03): 207-214
DOI: 10.1055/s-0034-1382158
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Timing of Eptifibatide Administration on Preprocedural Infarct-Related Artery Patency in Acute STEMI Patients Undergoing Primary PCI

Surya Dharma
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Isman Firdaus
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Siska Suridanda Danny
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Dafsah A. Juzar
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Alexander J. Wardeh
2   Department of Cardiology, M.C Haaglanden, The Hague, The Netherlands
,
J. Wouter Jukema
3   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
,
Arnoud van der Laarse
3   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
25 June 2014 (online)

    Permissions and Reprints

Abstract

The appropriate timing of eptifibatide initiation for acute ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. This study aimed to analyze the impact of timing of eptifibatide administration on infarct-related artery (IRA) patency in STEMI patients undergoing primary PCI. Acute STEMI patients who underwent primary PCI (n = 324) were enrolled in this retrospective study; 164 patients received eptifibatide bolus ≤ 30 minutes after emergency department (ED) admission (group A) and 160 patients received eptifibatide bolus > 30 minutes after ED admission (group B). The primary endpoint was preprocedural IRA patency. Most patients in group A (90%) and group B (89%) were late presenters (> 2 hours after symptom onset). The two groups had similar preprocedural thrombolysis in myocardial infarction 2 or 3 flow of the IRA (26 vs. 24%, p = not significant [NS]), similar creatine kinase-MB (CK-MB) levels at 8 hours after admission (339 vs. 281 U/L, p = NS), similar left ventricular ejection fraction (LVEF) (52 vs. 50%, p = NS), and similar 30-day mortality (2 vs. 7%, p = NS). Compared with group B, patients in group A had shorter door-to-device time (p < 0.001) and shorter procedural time (p = 0.004), without increased bleeding risk (13 vs. 18%, p = NS). Earlier intravenous administration of eptifibatide before primary PCI did not improve preprocedural IRA patency, CK-MB level at 8 hours after admission, LVEF and 30-day mortality compared with patients who received intravenous eptifibatide that was administered later.

Keywords

glycoprotein IIb/IIIa inhibitor - timing of administration - primary PCI

Note

This is an original article, and is not being submitted elsewhere.


 

  • References

  • 1 Zijlstra F, Hoorntje JC, de Boer MJ , et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341 (19) 1413-1419
    CrossrefPubMedGoogle Scholar
  • 2 Dalby M, Bouzamondo A, Lechat P, Montalescot G. Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation 2003; 108 (15) 1809-1814
    CrossrefPubMedGoogle Scholar
  • 3 Keeley EC, Boura JA, Grines CL. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet 2006; 367 (9510) 579-588
    CrossrefPubMedGoogle Scholar
  • 4 Dharma S, Juzar DA, Firdaus I, Soerianata S, Wardeh AJ, Jukema JW. Acute myocardial infarction system of care in the third world. Neth Heart J 2012; 20 (6) 254-259
    CrossrefPubMedGoogle Scholar
  • 5 Dharma S, Kedev S, Jukema JW. Thrombus management in the catheterisation laboratory in the setting of primary percutaneous coronary intervention: what is the current evidence?. Heart 2013; 99 (4) 279-284
    CrossrefPubMedGoogle Scholar
  • 6 Henriques JPS, Zijlstra F, Ottervanger JP , et al. Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction. Eur Heart J 2002; 23 (14) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 7 Kiernan TJ, Ting HH, Gersh BJ. Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls. Eur Heart J 2007; 28 (13) 1545-1553
    CrossrefPubMedGoogle Scholar
  • 8 Boersma E, Harrington RA, Moliterno DJ , et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet 2002; 359 (9302) 189-198
    CrossrefPubMedGoogle Scholar
  • 9 Hassan AKM, Liem SS, van der Kley F , et al. In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: results from the Leiden MISSION! acute myocardial infarction treatment optimization program. Catheter Cardiovasc Interv 2009; 74 (2) 335-343
    PubMedGoogle Scholar
  • 10 Stone GW, Cox D, Garcia E , et al. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104 (6) 636-641
    CrossrefPubMedGoogle Scholar
  • 11 Bekkers SCAM, Yazdani SK, Virmani R, Waltenberger J. Microvascular obstruction: underlying pathophysiology and clinical diagnosis. J Am Coll Cardiol 2010; 55 (16) 1649-1660
    CrossrefPubMedGoogle Scholar
  • 12 Schiller NB, Shah PM, Crawford M , et al. Recommendations for quantification of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography. . American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2 (5) 358-367
    CrossrefPubMedGoogle Scholar
  • 13 The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med 1993; 329 (10) 673-682
    CrossrefPubMedGoogle Scholar
  • 14 Smith Jr SC, Feldman TE, Hirshfeld Jr JW , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47 (1) e1-e121
    PubMedGoogle Scholar
  • 15 Van't Hof AW, Ten Berg J, Heestermans T , et al. Ongoing Tirofiban In Myocardial infarction Evaluation (On-TIME) 2 study group. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet 2008; 372: 537-546
    CrossrefPubMedGoogle Scholar
  • 16 Ohlmann P, Reydel P, Jacquemin L , et al. Prehospital abciximab in ST-segment elevation myocardial infarction: results of the randomized, double-blind MISTRAL study. Circ Cardiovasc Interv 2012; 5 (1) 69-76 , S1
    CrossrefPubMedGoogle Scholar
  • 17 Aquilina M, Varani E, Balducelli M, Vecchi G, Frassineti V, Maresta A. Administration of eptifibatide during transfer for primary PCI in patients with STEMI: effect on Pre-PCI TIMI flow and its correlation with pain-to-therapy time. J Invasive Cardiol 2009; 21 (3) 115-120
    PubMedGoogle Scholar
  • 18 Gibson CM, Kirtane AJ, Murphy SA , et al; TIMI Study Group. 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. Am Heart J 2006; 152 (4) 668-675
    CrossrefPubMedGoogle Scholar
  • 19 De Luca G, Bellandi F, Huber K , et al. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient's data meta-analysis. J Thromb Haemost 2011; 9 (12) 2361-2370
    CrossrefPubMedGoogle Scholar
  • 20 Ellis SG, Tendera M, de Belder MA , et al; FINESSE Investigators. Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med 2008; 358 (21) 2205-2217
    CrossrefPubMedGoogle Scholar
  • 21 Ellis SG, Tendera M, de Belder MA , et al; FINESSE Investigators. 1-year survival in a randomized trial of facilitated reperfusion: results from the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial. JACC Cardiovasc Interv 2009; 2 (10) 909-916
    CrossrefPubMedGoogle Scholar
  • 22 Zeymer U, Zahn R, Schiele R , et al. Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial. Eur Heart J 2005; 26 (19) 1971-1977
    CrossrefPubMedGoogle Scholar
  • 23 Cutlip DE, Cove CJ, Irons D , et al. Emergency room administration of eptifibatide before primary angioplasty for ST elevation acute myocardial infarction and its effect on baseline coronary flow and procedure outcomes. Am J Cardiol 2001; 88 (1) A6, 62-64
    PubMedGoogle Scholar
  • 24 Steg PG, James SK, Atar D , et al; Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33 (20) 2569-2619
    CrossrefPubMedGoogle Scholar
  • 25 Van de Werf F, Barron HV, Armstrong PW , et al; ASSENT-2 Investigators. Assessment of the Safety and Efficacy of a New Thrombolytic. Incidence and predictors of bleeding events after fibrinolytic therapy with fibrin-specific agents: a comparison of TNK-tPA and rt-PA. Eur Heart J 2001; 22 (24) 2253-2261
    CrossrefPubMedGoogle Scholar
  • 26 Zeymer U. The role of eptifibatide in patients undergoing percutaneous coronary intervention. Expert Opin Pharmacother 2007; 8 (8) 1147-1154
    CrossrefPubMedGoogle Scholar
  • 27 De Luca G, Ucci G, Cassetti E, Marino P. Benefits from small molecule administration as compared with abciximab among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-analysis. J Am Coll Cardiol 2009; 53 (18) 1668-1673
    CrossrefPubMedGoogle Scholar
  • 28 Akerblom A, James SK, Koutouzis M , et al. Eptifibatide is noninferior to abciximab in primary percutaneous coronary intervention: results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). J Am Coll Cardiol 2010; 56 (6) 470-475
    CrossrefPubMedGoogle Scholar
  • 29 Ottani F, La Vecchia L, De Vita M, Catapano O, Tarantino F, Galvani M. Comparison by meta-analysis of eptifibatide and tirofiban to abciximab in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2010; 106 (2) 167-174 , e1
    CrossrefPubMedGoogle Scholar
  • 30 Zeymer U, Margenet A, Haude M , et al. Randomized comparison of eptifibatide versus abciximab in primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: results of the EVA-AMI Trial. J Am Coll Cardiol 2010; 56 (6) 463-469
    CrossrefPubMedGoogle Scholar
  • 31 Bradley EH, Herrin J, Wang Y , et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006; 355 (22) 2308-2320
    CrossrefPubMedGoogle Scholar
  • 32 Rathore SS, Curtis JP, Chen J , et al; National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009; 338: b1807
    CrossrefPubMedGoogle Scholar
  • 33 Danchin N. Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes. JACC Cardiovasc Interv 2009; 2 (10) 901-908
    CrossrefPubMedGoogle Scholar
  • 34 Levine GN, Bates ER, Blankenship JC , et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79 (3) 453-495
    CrossrefPubMedGoogle Scholar