Better Outcomes After Intracoronary Eptifibatide

By Will Boggs, MD

NEW YORK (Reuters Health) Sept 14 - Intracoronary bolus administration of eptifibatide may provide better immediate and intermediate outcomes than intravenous administration, according to a report by researchers in Saudi Arabia.

"Intracoronary drug delivery of eptifibatide and perhaps other platelet glycoprotein inhibitors is safe and effective, with less systemic bleeding complications, and continuous intravenous infusion may not be required with cost saving," Dr. Walid Hassan from King Faisal Specialist Hospital and Research Center, Riyadh, told Reuters Health.

Dr. Hassan and associates evaluated the immediate and intermediate (up to 24 months) results of 376 patients assigned to intracoronary eptifibatide administration during percutaneous coronary intervention (PCI), compared with intravenous bolus and continuous administration during PCI.

Higher TIMI III flow was achieved in the intracoronary group without acute or subacute stent thrombosis, the authors report.

The composite end point of death and myocardial infarction was significantly less likely to occur among patients treated with intracoronary eptifibatide, and the cumulative odds of death or MI for the intravenous group were 4-fold greater compared with the group that received intracoronary bolus eptifibatide only and 1.6-fold greater than the group that received intracoronary bolus eptifibatide followed by intravenous eptifibatide.

Moreover, the lowest odds of target vessel revascularization were in the intracoronary bolus group, as were the lowest odds of bleeding and the lowest frequency of hospitalization.

There were no complications during intracoronary administration of eptifibatide, the researchers report in the August issue of the American Heart Journal.

Dr. Hassan said they routinely use intracoronary eptifibatide in this setting, "but we will study other glycoprotein IIb/IIIa inhibitors, large and small molecules."

"We plan to do prospective multicenter trials to compare these regimens in saphenous vein graft intervention and in multivessel diabetic intervention," Dr. Hassan said.