WJCD  Vol.4 No.12 , November 2014
Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration
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.

Cite this paper
Mahmoud, S. (2014) Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration. World Journal of Cardiovascular Diseases, 4, 570-579. doi: 10.4236/wjcd.2014.412069.
[1]   Winchester, D.E., Wen, X., Brearley, W.D., et al. (2011) Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors during Elective Coronary Revascularization: A Meta-Analysis of Randomized Trials Performed in the Era of Stents and Thienopyridines. Journal of the American College of Cardiology, 57, 1190-1199.

[2]   Steg, P.G., Dabbous, O.H., Feldman, L.J., Cohen-Solal, A., Aumont, M.C., López-Sendón, J., Budaj, A., Goldberg, R.J., Klein, W. and Anderson Jr., F.A. (2004) Global Registry of Acute Coronary Events Investigators. Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation, 109, 494-499.

[3]   Armstrong, P.W. (2006) A Comparison of Pharmacologic Therapy with/without Timely Coronary Intervention vs Primary Percutaneous Intervention Early after ST-Elevation Myocardial Infarction: The WEST (Which Early ST-Elevation Myocardial Infarction Therapy) Study. European Heart Journal, 27, 1530-1538.

[4]   Stone, G.W. (2008) Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions. Circulation, 118, 552-566.

[5]   Singh, M., Reeder, G.S., Ohman, E.M., et al. (2001) Does the Presence of Thrombus Seen on a Coronary Angiogram Affect the Outcome after Percutaneous Coronary Angioplasty? An Angiographic Trials Pool Data Experience. Journal of the American College of Cardiology, 38, 624-630.

[6]   Vlaar, P.J., Svilaas, T., van der Horst, I.C., Diercks, G.F.H., Fokkema, M.L., de Smet, B.J.G.L., van den Heuvel, A.F.M., Anthonio, R.L., Jessurun, G.A., Tan, E., Suurmeijer, A.J.H. and Zijlstra, F. (2008) Cardiac Death and Reinfarction after 1 Year in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS): A 1-Year Follow-Up Study. Lancet, 371, 1915-1920.

[7]   Gibson, C.M., Zorkun, C. and Kunadian, V. (2008) Intracoronary Administration of Abciximab in ST-Elevation Myocardial Infarction. Circulation, 118, 6-8.

[8]   Thiele, H., Schindler, K., Friedenberger, J., et al. (2008) Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in STElevation Myocardial Infarction Trial. Circulation, 118, 49-57.

[9]   Ten Berg, J.M., van’t Hof, A.W.J., Dill, T., et al. (2010) Effect of Early, Pre-Hospital Initiation of High Bolus Dose Tirofiban in Patients with ST-Segment Elevation Myocardial Infarction on Short- and Long-Term Clinical Outcome (ON TIME 2). Journal of the American College of Cardiology, 55, 2446-2455.

[10]   Schroder, R., Zeymer, U., Wegscheider, K. and Neuhaus, K.L. (1999) Comparison of the Predictive Value of ST Segment Elevation Resolution 90 and 180 Minutes after Start of Streptokinase in Acute Myocardial Infarction. A Substudy of the Hirudin for Improvement of Thrombolysis (HIT)-4 Study. European Heart Journal, 20, 1563-1571.

[11]   Gibson, C.M., Cannon, C.P., Murphy, S.A., Ryan, K.A., Mesley, R., Marble, S.J., Mc Cabe, C.H., van De Werf, F. and Braunwald, E. (2000) The Relationship of the TIMI Myocardial Perfusion Grade to Mortality Following Thrombolytic Administration. Circulation, 101, 125-130.

[12]   Roe, M.T., Ohman, E.M., Maas, A.C., Christenson, R.H., Mahaffey, K.W., Gronger, C.B., et al. (2001) Shifting the Open Artery Hypothesis Downstream: The Quest for Optimal Reperfusion. Journal of the American College of Cardiology, 37, 9-18.

[13]   Cannon, C.P. (2001) Importance of TIMI3 Flow. Circulation, 104, 624-626.

[14]   Natarajan, D. (2011) Combined Intracoronary Glycoprotein Inhibitors and Manual Thrombus Extraction in Patients with Acute ST-Segment Elevation Myocardial Infarction—Does Incorporation of Both Have a Legitimate Role? Interventional Cardiology, 6, 182-185.

[15]   Erden, I., Ozhan, H. and Ordu, S. (2010) A Case of Stent Thrombosis Treated Successfully with Intracoronary Tirofiban. Kardiologia Polska, 68, 485-487.

[16]   Natarajan, D., Mukherjee, N., Yadav, A., et al. (2010) Intracoronary Tirofiban with Plain Balloon Angioplasty for Subacute Stent Thrombosis.

[17]   Ashraf, T., Rasool, S.I., Saghir, T., Rizvi, S.N., Qamar, N., Zaman, K.S., Ishaque, M. and Kundi, A. (2007) Aspiration of Thrombus in ST Segment Elevation Myocardial Infarction. Journal of Pakistan Medical Association, 57, 359-362.

[18]   De Vita, M., Burzotta, F., Porto, I., Dudek, D., Lefèvre, T., Trani, C., Mielecki, W., Niccoli, G., Biondi-Zoccai, G.G. and Crea, F. (2010) Thrombus Aspiration in ST Elevation Myocardial Infarction: Comparative Efficacy in Patients Treated Early and Late after Onset of Symptoms. Heart, 96, 1287-1290.

[19]   Ikari, Y., Sakurada, M., Kozuma, K., Kawano, S., Katsuki, T., Kimura, K., Suzuki, T., Yamashita, T., Takizawa, A., Misumi, K., Hashimoto, H. and Isshiki, T., VAMPIRE Investigators. (2008) Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients with ST-Segment Elevation Acute Myocardial Infarction: Report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) Trial. JACC-Cardiovascular Interventions, 1, 424-431.