Comparison between the Outcomes of Intracoronary and Intravenous Administration of Eptifibatide during Primary Percutaneous Coronary Intervention in Patients with Acute ST-Elevation Myocardial Infarction

Aim: To compare the outcomes of intracoronary (IC) and intravenous (IV) administration of eptifibatide during primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Methods: In this prospective double-blind randomized clinical trial, 76 patients with STEMI selected for PPCI were randomly assigned in two groups to receive either IC or IV bolus of eptifibatide. The primary end point was coronary perfusion assessment by thrombolysis in myocardial infarction (TIMI) flow grade (TFG), TIMI perfusion grade (TPG), and corrected TIMI frame count (cTFC). Secondary end points were left ventricular ejection fraction (LVEF) restoration, ST-segment elevation resolution, and in-hospital major cardiovascular adverse events (MACEs) (including recurrent MI, need for target vessel revascularization (TVR), stroke, and death resulting from any cause) until discharge. Results: Assessment revealed significantly better TFG (95% CI: 1.01-10.26, OR = 3.224, P = 0.042), more TFG 3 (65.79% vs. 86.11% in IV and IC groups, respectively), better TPG (P = 0.024), more achieved TPG 3 and TPG 2+3 (TPG 3: 44.74% vs. 72.22% and TPG 2+3: 78.95% vs. 94.44% in the IV and IC groups, respectively) with better cTFC in the IC group (37.33 +/- 15.84 vs. 32.53 +/- 20.71 in the IV and IC groups, respectively; P = 0.034). LVEF was better restored in the IC group (6.21 +/- 8.61% vs. 14.72 +/- 5.34% in the IV and IC groups, respectively; P < 0.001) and the ST-segment elevation resolution was better achieved in the IC administration (95% CI: -22.55 to -6.23, P = 0.001). There were no recurrent MI, stroke, or need for TVR among patients during the in-hospital stay. Conclusions: IC administration of eptifibatide during PPCI in patients with STEMI in comparison with IV administration of eptifibatide is associated with significantly better coronary reperfusion and improved clinical outcomes (IRCT2012090510751N1).