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Glycoprotein IIb/IIIa inhibition has been a mainstay in acute myocardial infarction intervention. Major bleeding is a predictor of adverse outcomes in ST elevation myocardial infarction (STEMI).
To determine the safety and bleeding outcomes of abbreviated compared to standard infusions of the glycoprotein IIb/IIIa inhibitor eptifibatide in the setting of primary PCI for STEMI.
We analyzed a retrospective cohort of 93 STEMI patients who received abbreviated (<18 hours) infusion of eptifibatide and compared them to 91 STEMI patients with standard (18 hours) infusion in primary PCI, from June 2009 to June 2011, at a single cardiac centre. Detailed chart review of demographic and clinical characteristics, times to intervention, complications, electrocardiographic (ECG) findings, bleeding, ejection fraction (EF), and stent thrombosis data was performed. Descriptive statistics were utilized to outline safety and efficacy outcomes. A p-value <0.05 was considered significant.
There was no significant difference between the two groups in complications including GI bleeding, hematoma larger than 5 cm, fistula or pseudo-aneurysm, retroperitoneal hemorrhage (RPH) or hemoglobin drop more than 50 g/L. Closure devices were deployed more in abbreviated infusion (65% vs. 44%, p-value: 0.004). There was a trend towards improved ST elevation resolution > 50% in standard infusion (78% vs. 66%, p-value: 0.06) and CK peaked higher in abbreviated infusion (2088.9 +/- 1982 vs. 1565 +/- 1545, p-value; 0.05). There was no significant difference in stent thrombosis or EF (47.25% +/- 9.46 vs. 49.4% +/- 9.2 for abbreviated and standard infusion respectively, p-value: 0.12). There was no significant difference in transfusion (3% vs. 5% for abbreviated and standard infusion respectively, p-value: 0.44) or death (3.2% vs. 1.1% for abbreviated and standard infusion respectively, p-value: 0.37).
Abbreviated duration glycoprotein IIb/IIIa inhibition may be a safe and novel alternative to standard infusion during STEMI. Although there was no significant difference in bleeding or vascular complications between abbreviated and standard infusion groups, along with a trend towards better ST resolution and lower CK in standard infusion group, but there was no significant difference in stent thrombosis, EF or death between the two groups. Further large prospective randomized controlled trials are indicated to study this approach to reduce bleeding in this high risk population.