BACKGROUND: Early restoration of epicardial flow before primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been associated with improved clinical outcomes. METHODS: We hypothesized that early administration of the glycoprotein IIb/IIIa inhibitor eptifibatide in the emergency department (ED) would yield superior epicardial flow and myocardial perfusion before primary PCI compared with initiating eptifibatide after diagnostic angiography in the cardiac catheterization laboratory (CCL). Three hundred forty-three patients with STEMI were randomized to either early ED eptifibatide (n = 180) or CCL eptifibatide (n = 163). RESULTS: The primary end point (pre-PCI corrected TIMI frame count) was significantly lower (faster flow) with early eptifibatide (77.5 +/- 32.2 vs 84.3 +/- 30.7, P = .049). The incidence of normal pre-PCI TIMI myocardial perfusion was increased among patients treated in the ED versus CCL (24% vs 14%, P = .026). There was no excess of TIMI major or minor bleeding among patients treated in the ED versus CCL (6.9% [12/174] vs 7.8% [11/142], P = NS). CONCLUSION: A strategy of early initiation of eptifibatide in the ED before primary PCI for STEMI yields superior pre-PCI TIMI frame counts, reflecting epicardial flow, and superior TIMI myocardial perfusion compared with a strategy of initiating eptifibatide in the CCL without an increase in bleeding risk.
RCT Entities:
BACKGROUND: Early restoration of epicardial flow before primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been associated with improved clinical outcomes. METHODS: We hypothesized that early administration of the glycoprotein IIb/IIIa inhibitor eptifibatide in the emergency department (ED) would yield superior epicardial flow and myocardial perfusion before primary PCI compared with initiating eptifibatide after diagnostic angiography in the cardiac catheterization laboratory (CCL). Three hundred forty-three patients with STEMI were randomized to either early ED eptifibatide (n = 180) or CCLeptifibatide (n = 163). RESULTS: The primary end point (pre-PCI corrected TIMI frame count) was significantly lower (faster flow) with early eptifibatide (77.5 +/- 32.2 vs 84.3 +/- 30.7, P = .049). The incidence of normal pre-PCI TIMI myocardial perfusion was increased among patients treated in the ED versus CCL (24% vs 14%, P = .026). There was no excess of TIMI major or minor bleeding among patients treated in the ED versus CCL (6.9% [12/174] vs 7.8% [11/142], P = NS). CONCLUSION: A strategy of early initiation of eptifibatide in the ED before primary PCI for STEMI yields superior pre-PCI TIMI frame counts, reflecting epicardial flow, and superior TIMI myocardial perfusion compared with a strategy of initiating eptifibatide in the CCL without an increase in bleeding risk.
Authors: Giuseppe De Luca; C Michael Gibson; Francesco Bellandi; Marko Noc; Mauro Maioli; Simona Zorman; Uwe Zeymer; H Mesquita Gabriel; Ayse Emre; Donald Cutlip; Hans-Richard Arntz; Dariusz Dudek; Tomasz Rakowski; Maryann Gyongyosi; Kurt Huber; Arnoud W J van't Hof Journal: J Thromb Thrombolysis Date: 2010-07 Impact factor: 2.300
Authors: Giuseppe De Luca; C Michael Gibson; Francesco Bellandi; Sabina Murphy; Mauro Maioli; Marko Noc; Uwe Zeymer; Dariusz Dudek; Hans-Richard Arntz; Simona Zorman; H Mesquita Gabriel; Ayse Emre; Donald Cutlip; Tomasz Rakowski; Mariann Gyongyosi; Kurt Huber; Arnoud W J Van't Hof Journal: J Thromb Thrombolysis Date: 2008-11-22 Impact factor: 2.300
Authors: Enrico Fabris; Serge Korjian; Barry S Coller; Jurrien M Ten Berg; Christopher B Granger; C Michael Gibson; Arnoud W J van 't Hof Journal: Thromb Haemost Date: 2021-04-30 Impact factor: 6.681
Authors: G De Luca; C M Gibson; F Bellandi; S Murphy; M Maioli; M Noc; U Zeymer; D Dudek; H-R Arntz; S Zorman; H M Gabriel; A Emre; D Cutlip; G Biondi-Zoccai; T Rakowski; M Gyongyosi; P Marino; K Huber; A W J van't Hof Journal: Heart Date: 2008-05-12 Impact factor: 5.994