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Published on: January 18, 2018
Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with
Matthew T Roe1, Cynthia L Green, Robert P Giugliano
1Duke Clinical Research Institute and Division of Cardiology, Duke Medical Center, Durham, North Carolina 27715, USA. roe00001@mc.duke.edu
Insights
Combination therapy using reduced-dose tenecteplase and eptifibatide improved ST-segment recovery and angiographic results in acute myocardial infarction patients. This approach offers faster, more stable recovery compared to full-dose tenecteplase.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Combination therapy with reduced-dose fibrinolytics and glycoprotein IIb/IIIa inhibitors shows improved reperfusion biomarkers in ST-segment elevation myocardial infarction.
- However, this approach has not yet demonstrated a reduction in mortality compared to full-dose fibrinolytics.
Purpose of the Study:
- To evaluate the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide.
- To assess continuous ST-segment recovery and angiographic results in acute myocardial infarction.
Main Methods:
- 140 patients in the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial were analyzed.
- Continuous 24-h 12-lead ST-segment monitoring and 60-min angiography were performed.
- The reduced-dose regimen (50% tenecteplase + high-dose eptifibatide) was compared to full-dose tenecteplase.
Main Results:
- The combination regimen showed a faster median time to stable ST-segment recovery (55 vs. 98 min).
- Improved stable ST-segment recovery by 2 hours (89.6% vs. 67.7%) and reduced recurrent ischemia (34.0% vs. 57.1%) were observed.
- Findings correlated with improved angiographic results at 60 minutes.
Conclusions:
- Combination therapy with reduced-dose tenecteplase and eptifibatide accelerates and stabilizes ST-segment recovery.
- This regimen also improves angiographic flow patterns compared to full-dose tenecteplase.
- The study questions the direct link between reperfusion biomarkers and clinical outcomes.
Objectives:
This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and angiographic results.
Background:
Combination therapy with reduced-dose fibrinolytics and glycoprotein IIb/IIIa inhibitors for ST-segment elevation myocardial infarction improves biomarkers of reperfusion success but has not reduced mortality when compared with full-dose fibrinolytics.
Methods:
We evaluated 140 patients enrolled in the INTEGRITI trial with 24-h continuous 12-lead ST-segment monitoring and angiography at 60 min. The dose-combination regimen of 50% of standard-dose tenecteplase (0.27 microg/kg) plus high-dose eptifibatide (2 boluses of 180 microg/kg separated by 10 min, 2.0 microg/kg/min infusion) was compared with full-dose tenecteplase (0.53 microg/kg).
Results:
The dose-confirmation regimen of reduced-dose tenecteplase plus high-dose eptifibatide was associated with a faster median time to stable ST-segment recovery (55 vs. 98 min, p = 0.06), improved stable ST-segment recovery by 2 h (89.6% vs. 67.7%, p = 0.02), and less recurrent ischemia (34.0% vs. 57.1%, p = 0.05) when compared with full-dose tenecteplase. Continuously updated ST-segment recovery analyses demonstrated a modest trend toward greater ST-segment recovery at 30 min (57.7% vs. 40.6%, p = 0.13) and 60 min (82.7% vs. 65.6%, p = 0.08) with this regimen. These findings correlated with improved angiographic results at 60 min.
Conclusions:
Combination therapy with reduced-dose tenecteplase and eptifibatide leads to faster, more stable ST-segment recovery and improved angiographic flow patterns, compared with full-dose tenecteplase. These findings question the relationship between biomarkers of reperfusion success and clinical outcomes.
