Administration of eptifibatide during transfer for primary PCI in patients with STEMI: effect on Pre-PCI TIMI flow and its correlation with pain-to-therapy time.

BACKGROUND

Facilitation therapy in ST-elevation myocardial infarction (STEMI) is still controversial and no relationship between timing of treatment and efficacy has been reported to date.

METHODS

In order to evaluate the effect of pre-catheterization laboratory (cath lab) administration of eptifibatide on pre-percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow and its correlation with ischemia duration, we studied all 438 STEMI patients treated with primary PCI from January 2006 to December 2007: 310 patients were pretreated with eptifibatide (Group P), while 128 patients received either no glycoprotein IIb/IIIa inhibitors or were only given them in the cath lab (Group C). All ischemia times (chest pain onset, diagnostic electrocardiogram, eptifibatide administration, cath lab arrival, first balloon inflation) were recorded. Group P was divided into early (E:159 patients with symptoms duration <or= 90 minutes, and late (L: 151 patients) subgroups. Pre- and post-PCI TIMI grade flow, and 30-day outcomes were recorded.

RESULTS

At angiography, TIMI grade 2 or 3 flow was observed in 54% of cases in Group P vs. 34% in Group C (p < 0.001), and in 64% vs. 44% in E and L subgroups, respectively (p < 0.001). In Group P, there was a strong correlation between pre-PCI TIMI flow and timing of eptifibatide administration. Pretreatment with eptifibatide and symptom duration of <or= 90 minutes resulted in independent predictors of pre-PCI TIMI >or= 2 flow on multivariable analysis. Thirtyday mortality was 1.9% in Group P and 9.5% in Group C (p < 0.001).

CONCLUSIONS

In our experience, very early (< 90 minutes) eptifibatide therapy prior to primary PCI achieves a higher rate of pre-PCI TIMI flow >or= 2 with respect to late administration.