Key result
Intracoronary eptifibatide bolus alone during PCI was associated with lower 24-month cumulative TVR (12.5% vs 34%, P=0.018) and death or MI (2.5% vs 9.4%, P=0.015) compared to IV bolus and infusion.
Why the study?
Does intracoronary eptifibatide bolus alone improve clinical and safety outcomes compared to regimens involving continuous IV infusion in patients undergoing PCI?
Cohort (n=376)
Does intracoronary eptifibatide bolus alone improve clinical and safety outcomes compared to regimens involving continuous IV infusion in patients undergoing PCI?
Absolute Event Rate: 12.5% vs 34%
p-value: p=0.018
Intracoronary bolus administration of eptifibatide alone during PCI may be safer and more effective than standard regimens requiring continuous IV infusion.
May support intracoronary eptifibatide bolus alone in PCI; hypothesis-generating and requires randomized confirmation before any practice change.
Objectives. To evaluate the intermediate 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. There is no present data available considering giving eptifibatide during PCI as IC bolus alone. Methods : Clinical outcomes of 376 patients who received stents + eptifibatide by 3 different routes during PCI and were followed up for over 24 months. Group A (119 patients) had IC eptifibatide bolus only; group B (119 patients) had IC bolus and continuous IV infusion and group C (138 patients) had IV bolus and continuous IV infusion. The standard systemic bolus doses of eptifibatide 180 micg /kg was given either via IC or IV route and only groups B and C received continuous IV infusion at 2 micg /kg/min for 18–24 hours. Results : Patients, procedural characteristics and outcomes are shown (Table). The 6, 12, 24-month cumulative TVR was lower in group A (6.7, 11.7, 12.5%) compared to group B (9.2, 14.2, 15 %) and group C (17.4, 30.4, 34 %) P = 0.018 as well as the composite endpoint of death or MI (2.5, 5.8, 9.4) P = 0.015. The frequency of major, minor bleeding and rehospitalization was significantly lower in-group A (2.4, 5.8, 10.9%) compared to group B (7.5, 11.7, 16.8%) and group C (9.5, 17, 28%) P Conclusion : The IC bolus alone route 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 validate these findings.
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Hassan et al. (2006) conducted a cohort in Patients undergoing percutaneous coronary intervention (PCI) (n=376). Intracoronary (IC) eptifibatide bolus alone vs. IC bolus + continuous IV infusion or IV bolus + continuous IV infusion was evaluated on 24-month cumulative target vessel revascularization (TVR) (p=0.018). Intracoronary eptifibatide bolus alone during PCI was associated with lower 24-month cumulative TVR (12.5% vs 34%, P=0.018) and death or MI (2.5% vs 9.4%, P=0.015) compared to IV bolus and infusion.
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