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. 2014 Sep;23(3):207-14.
doi: 10.1055/s-0034-1382158.

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

Surya Dharma  1 , Isman Firdaus  1 , Siska Suridanda Danny  1 , Dafsah A Juzar  1 , Alexander J Wardeh  2 , J Wouter Jukema  3 , Arnoud van der Laarse  3
Affiliations

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

Surya Dharma et al. Int J Angiol. 2014 Sep.

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; primary PCI; timing of administration.

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Conflict of interest statement

Funding None. Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Flowchart of the study. ED, emergency department; IV, intravenous; PPCI, primary percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.
Fig. 2
Fig. 2
Primary endpoint: Pre-PCI TIMI flow 2 or 3 by the treatment group. Group A: patients who received intravenous eptifibatide within 30 minutes after emergency department admission; group B: patients who received eptifibatide bolus after the first 30 minutes of emergency department admission. NS, not significant; PCI, percutaneous coronary intervention; TIMI, thrombolysis in myocardial infarction.
See this image and copyright information in PMC

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