Key result
Intracoronary bolus eptifibatide during primary PCI significantly improved myocardial blush grade 3 (42% vs 10%, P=0.005) and 30-day ejection fraction compared to intravenous administration.
Why the study?
It remained unclear whether direct intracoronary injection of eptifibatide provides superior benefit compared to routine intravenous administration during primary PCI.
Does bolus intracoronary eptifibatide improve myocardial salvage compared to bolus intravenous eptifibatide in patients with anterior STEMI undergoing primary PCI?
RCT (n=100)
randomized
Does bolus intracoronary eptifibatide improve myocardial salvage compared to bolus intravenous eptifibatide in patients with anterior STEMI undergoing primary PCI?
Absolute Event Rate: 42% vs 10%
p-value: p=0.005
Intracoronary bolus administration of eptifibatide during primary PCI for anterior STEMI improves microvascular perfusion and short-term left ventricular systolic function compared to intravenous administration.
Intracoronary eptifibatide may improve blush grade and LVEF in anterior STEMI; leaves open superiority over intravenous dosing pending larger trials.
Background.Eptifibatide achieves high local concentration via direct intracoronary (I/V) injection as it promotes clot disaggregation, but it remains unclear if it is of superior benefit than the routine intravenous (I/V) administration. Aim. The current study aimed to examine the safety and efficacy of I/C vs I/V bolus regimen dose of eptifibatide during primary percutaneous coronary intervention (PPCI). Material and methods. Prospective, controlled, randomized study enrolled 100 patients with acute anterior ST-segment elevation myocardial infarction (STEMI) eligible for PPCI equally divided into 2 groups (group A received bolus I/C eptifibatide and group B received it I/V) followed by 12-hour continuous I/V infusion. Features related to of myocardial salvage in the form of TIMI flow grade 3, myocardial blush grade 3, ST segment resolution and left ventricular systolic function were evaluated with short-term follow up for 1 month. Results. Mean age of the study population was 50.95±8.45years, there was statistically insignificant difference between both groups regarding baseline characteristics in age (p=0.062), gender (p=0.488), coronary artery disease risk factors (p>0.05), time from onset of pain to admission (p=0.86) or door to balloon (p=0.12). Group A achieved statistically significant better myocardial blush grade 3 (42% vs 10%, p=0.005), ejection faction 30 days after PPCI (46.11±7.81% vs 40.88±6.26%, p=0.005) but statistically insignificant TIMI flow grade 3 (p=0.29) and ST resolution (p=0.34). Incidence of complications in the hospital and 30 days after discharge was statistically insignificant (p>0.05). Conclusion. Both regimens were safe and effective in STEMI patients undergoing PPCI and regimen of I/C bolus eptifibatide achieved better myocardial blush grade and systolic function.
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Nab et al. (2019) conducted an RCT in acute anterior ST-segment elevation myocardial infarction (STEMI) (n=100). Intracoronary bolus eptifibatide vs. Intravenous bolus eptifibatide was evaluated on Myocardial blush grade 3 (p=0.005). Intracoronary bolus eptifibatide during primary PCI significantly improved myocardial blush grade 3 (42% vs 10%, P=0.005) and 30-day ejection fraction compared to intravenous administration.
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