The effect of intracoronary versus intralesional injection of eptifibatide on myocardial perfusion outcomes during primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction; A randomized clinical trial study

BACKGROUND: Previous studies have proved that intracoronary injection of eptifibatide is safe and more effective in infarct size reduction and clinical outcomes than intravenously injection in the patients with acute myocardial infarction (AMI). This study aimed to compare the effect of localized and intracoronary injection of eptifibatide on myocardial perfusion improvement and its outcomes.METHODS: We conducted a randomized clinical trial study of ۶۰ patients presented with thrombotic AMI. The patients underwent percutaneous coronary intervention (PCI), and were randomly divided into two equal number groups. The first group received two bolus doses of ۱۸۰ μg/kg eptifibatide through guiding catheter. The second group received the same bolus doses through export aspiration catheter into the coronary lesion directly. Thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and no-reflow phenomenon were primary end points. Secondary end points were pre- and postprocedure cardiac arrhythmia, in-hospital mortality, adverse effects, reinfection, pre-discharge ventricular systolic function, and re-hospitalization and mortality after ۶ month of follow up.RESULTS: The mean ages of group I and group II were ۵۸.۳ ± ۱.۸ and ۵۷.۰ ±۲.۰ years, respectively, and most of patient were men (۹۰% in group I and ۸۰% in group II). Postprocedural TIMI flow grade ۳ was achieved in ۶۰.۰% and ۷۶.۷% of the intracoronary and intralesional groups, respectively (P = ۰.۳۰۷). Postprocedural MBG grade ۳ was achieved in ۵۳.۳% and ۷۰.۰% in intracoronary and intralesional groups, respectively (P = ۰.۴۷۹). There was no significant difference between the groups in no-reflow assessment. Moreover, no significant difference was seen between the two groups in secondary end-point analysis.CONCLUSION: Both methods of intracoronary and intralesional eptifibatide administration during primary PCI in patients with acute ST-elevation myocardial infarction (STEMI) were safe and similar in myocardial perfusion outcomes.

Keywords:

Myocardial Perfusion Imaging , Eptifibatide , Myocardial Infarction