Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Abstract

Aim of the work: To evaluate the efficacy and safety of bolus only intra coronary platelet glyco-protein GP IIb/IIIa receptor antagonists combined with thrombus-aspiration during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Patient and Methods: 25 consecutive STEMI patients treated by primary PCI including thrombus aspiration were prospectively enrolled, from a total of 180 PCIs performed at our institution between January 2013 and January 2014. All patients received aspirin (250 mg i.v.) and clopidogrel (600 or 300 mg if already on clopidogrel) plus standard heparin. Glycoprotein IIb/IIIa antagonists were administered at physicians’ discretion before thrombus aspiration. Eptifibatide was used as a slandered Glycoprotein IIb/IIIa antagonists as a dose of the 180-μg/kg eptifibatide bolus only. The bolus was administered for 2 minutes via the thrombus aspiration catheter (STEMI cath of min-vasys) just before thrombus aspiration. Twelve-lead ECGs were recorded at baseline and 60 min (45 - 75 min) after completion of PCI. The primary endpoint was the TIMI 3 patency of the infarct-related coronary artery before PCI. Secondary endpoints were TIMI patency following PCI, ST resolution 60 min after PCI, all-cause death, reinfarction, urgent revascularization, stroke (haemorrhagic, non-haemorrhagic), and severe bleeding complications. Results: The angiography was performed in all 25 patients. The incidence of a TIMI flow grade 3 of the infarct-related coronary artery before PCI was 16% while TIMI grade 2 and I was 24% and 36% respectively. The incidence of a TIMI flow grade 0 (no reflow) of the infarct-related coronary artery before PCI was 24%. Visible thrombus in 52% of patients and 40% of patients have more than one critically disease vessel. Primary PCI was performed in 25 patients. Eptifibatide intracoronary was given through thrombus aspiration catheter before thrombus aspiration. Drug eluting stents were implanted in 60% of patients. Only two patients with acute stent thrombosis did not receive any stents at PCI. One patient died 24 h after the procedure due to severe heart failure and cardiogenic shock. No reinfarction was noted within 30 days after the procedure. Generally heart failure improved significantly after the procedure and at the end of 30 day post operative. Only 3 patients had persistent heart failure class III (12%). 84% of patients had TIMI flow III at the end of procedure with over all significant improvement. Significant TIMI flow improvement after procedure was noticed with P value, 001. Also the results showed significant shows of ST segment resolution after procedure. Conclusions: for patients with STEMI undergoing primary PCI, a routine combination of intracoronary administration of Eptifibatide before transcatheter thrombus aspiration is a safe procedure with low risk of hemorrhage and increases myocardial reperfusion, which ultimately improves outcomes. This therapeutic modality may be recommended for further improving myocardial reperfusion in patients with STEMI.