Key result
Intracoronary bolus administration of eptifibatide alone during PCI significantly reduced the 7-year composite endpoint of death and myocardial infarction compared to intravenous administration (2.5% vs 10.8%, OR 4.3, p=0.029).
Why the study?
Does intracoronary eptifibatide bolus alone reduce the composite of death or MI compared to intravenous bolus and/or continuous infusion in patients undergoing percutaneous coronary intervention?
Observational (n=376)
Does intracoronary eptifibatide bolus alone reduce the composite of death or MI compared to intravenous bolus and/or continuous infusion in patients undergoing percutaneous coronary intervention?
Effect estimate: OR 4.3 (95% CI 1.16-15.77)
Absolute Event Rate: 2.5% vs 10.8%
p-value: p=0.029
Intracoronary bolus administration of eptifibatide without continuous infusion during PCI is associated with lower rates of death, MI, TVR, and bleeding compared to standard intravenous administration up to 7 years of follow-up.
Intracoronary eptifibatide bolus alone was associated with lower long-term death or MI after PCI; leaves open whether randomized trials will confirm benefit over intravenous regimens.
Objectives: This study evaluated the immediate, intermediate and 7-year results of intracoronary (IC) eptifibatide administration during percutaneous coronary intervention (PCI). Background: Several studies tested intravenous (IV) bolus and continuous administration of eptifibatide during PCI. However, limited data is available considering giving eptifibatide as IC bolus alone during PCI. Methods: Clinical outcomes of 376 patients who received coronary stent(s) + eptifibatide by three applications during PCI and were followed up for over 84 months. Group A (119 patients) had IC eptifibatide bolus only; group B (119 patients) had IC bolus and IV infusion and group C (138 patients) had IV bolus + infusion. The standard two boluses of eptifibatide 180 mcg/kg were given either via IC or IV route and only groups B and C received IV infusion at 2 mcg/kg/min for 18-24 hours. Results: There were 256 males and 120 females, mean age 57 ± 11. Among them 52% were diabetics. The 6, 12, 24, 84-month cumulative composite endpoint of death and myocardial infraction (MI) was lower in group A (2.5%) compared to group C (10.8%, OR 4.3, p = 0.029), and group-B (5.8%, OR 2.6, p = 0.17). Compared to group-A, target vessel revascularization (TVR) was three fold in group-C (OR 3.3, p = 0.001) and two-fold in group-B (OR 2.0, p = 0.061). Bleeding was significantly higher in Group-C (OR 5.4, p < 0.0001) and Group-B (OR 3.4, p = 0.007) compared to Group-A. Re-hospitalization was significantly lower in group A (10.9%) compared to group B (16.8%) and group C (28%) (P =0.0009). Conclusion: The IC bolus alone application of eptifibatide may be safer and superior to the IV route, and continuous infusion may not be necessary. Large-scale prospective randomized trials are needed to further validate these findings.
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Hassan et al. (2016) conducted an observational in Patients undergoing percutaneous coronary intervention (PCI) with coronary stent implantation (n=376). Intracoronary (IC) eptifibatide bolus alone vs. Intravenous (IV) bolus + IV infusion or IC bolus + IV infusion of eptifibatide was evaluated on Cumulative composite endpoint of death and myocardial infarction (MI) at 84 months (OR 4.3, 95% CI 1.16-15.77, p=0.029). Intracoronary bolus administration of eptifibatide alone during PCI significantly reduced the 7-year composite endpoint of death and myocardial infarction compared to intravenous administration (2.5% vs 10.8%, OR 4.3, p=0.029).
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