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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Integrilin in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction
Michael Mahmoudi1, Cedric Delhaye, Kohei Wakabayashi
1Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, DC, USA.
Insights
Adjunctive eptifibatide therapy in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) may improve outcomes. This study found reduced mortality and similar bleeding rates, suggesting a potential benefit for this critical patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The use of eptifibatide as an adjunct therapy in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is debated.
- This study aimed to evaluate the safety and efficacy of eptifibatide in STEMI patients undergoing primary PCI.
Purpose of the Study:
- To determine the clinical outcomes and safety profile of adjunctive eptifibatide therapy.
- To assess the impact of eptifibatide on mortality and major bleeding events in STEMI patients.
Main Methods:
- A cohort of 857 patients undergoing primary PCI for STEMI was analyzed.
- 318 patients received adjunctive eptifibatide therapy; thrombolysis prior to catheterization excluded.
- Primary endpoints included all-cause mortality and a composite of mortality or Q-wave MI; major bleeding was the safety endpoint.
Main Results:
- The eptifibatide group had lower rates of all-cause mortality (HR 0.55; P=0.01) and mortality or Q-wave MI (HR 0.59; P=0.03) at 6 months.
- Rates of Thrombolysis in Myocardial Infarction (TIMI) major bleeding were comparable between groups (HR 0.54; P=0.12).
- Baseline characteristics differed, with the eptifibatide group being younger and having fewer comorbidities.
Conclusions:
- Adjunctive eptifibatide therapy in STEMI patients undergoing primary PCI may be linked to enhanced clinical outcomes.
- The findings suggest a potential benefit of eptifibatide in improving survival and reducing adverse cardiac events without increasing bleeding risk.
Background:
The adjunctive use of eptifibatide in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains controversial. We therefore set out to determine the safety and efficacy of eptifibatide in this population.
Methods:
The study comprised 857 consecutive patients who underwent primary PCI for STEMI at the Washington Hospital Center. Three hundred eighteen patients also received adjunctive therapy with eptifibatide. Patients who had received thrombolysis prior to undergoing cardiac catheterization were excluded. The primary end-point was all-cause mortality and the composite of all-cause mortality or Q-wave MI. The primary safety end-point was the rate of thrombolysis in myocardial infarction (TIMI) major bleeding.
Results:
The eptifibatide group was younger, had a higher body mass index, and a lower proportion of patients with systemic hypertension, diabetes mellitus, previous history of ischemic heart disease, coronary revascularization, and congestive heart failure. This cohort also used bivalirudin less often (23.3% vs. 72%; P < 0.001). Following multivariable analysis, the eptifibatide group had a significantly lower rate of all-cause mortality (hazard ratio 0.55; 95% confidence interval 0.34-0.89; P = 0.01) and the composite of all-cause mortality or Q-wave MI (hazard ratio 0.59; 95% confidence interval 0.37-0.95; P = 0.03) at 6 months. The rate of TIMI major bleeding was similar in both groups (hazard ratio 0.54; 95% confidence interval 0.25-1.17; P = 0.12).
Conclusion:
The adjunctive use of eptifibatide in patients presenting with STEMI may be associated with improved clinical outcomes. (J Interven Cardiol 2011;24:351-356).
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