Efficacy And Safety Of Intracoronary Eptifibatide Bolus Administration During Percutaneous Coronary Intervention In Patients With Non-ST-Elevation Acute Coronary Syndrome

Objective: Coronary heart disease (CHD) is a disease on the basis ofatherosclerosis, it is presently the most prevalent cardiovascular disease in ourcountry. It does serious harm to human health. Non-ST segment elevationacute coronary syndrome (NSTE-ACS) is a kind of incomplete coronaryocclusion which is caused by coronary atherosclerotic plaque rupture andthrombosis (most of platelet-rich thrombus) secondary to plaque surface.Platelet activation, adhesion and aggregation play an important role in theprocess of this disease. Numerous studies demonstrated that anti-platelettherapy and PCI are the best option in middle-risk or high-risk group withNSTE-ACS. Platelet glycoprotein IIb/IIIa receptor antagonist has a strongeffect of anti-platelet aggregation and has Showed good efficacy in thetreatment of patients with ACS. In recent years, eptifibatide which is goingon the domestic market recently is a synthetic cyclic peptide GPⅡb/Ⅲareceptor antagonist. There are few related research about its efficacy onpatients with NSTE-ACS. In this prospective study, we will split theNSTE-ACS patients into two groups, one is using GPⅡb/Ⅲa receptorantagonist eptifibatide both in coronary and in vein for experimental group,and the other is placebo group with regular operational methods for non-eptifibatide during PCI. During this research, we will observe and comparingthe difference of revascularization circumstances, thrombolysis in myocardialinfarction (TIMI) flow, Corrected TIMI Frame Count (CTFC), TIMImyocardial perfusion grade (TMPG), bleeding complications, left ventricularejection fraction (LVEF), ADP-induced platelet aggregation and major adversecardiac events (MACE). Evaluate the Efficacy And Safety Of GPⅡb/Ⅲareceptor antagonist, eptifibatide, during PCI in patients with non-ST-elevation acute coronary syndrome.Methods: Choose eighty-three cases of patients (53males,30females, theaverage age of57.6±9.4years old) who had been diagnosed as NSTE-ACSin the Second Hospital of Hebei Medical University from February2013toJanuary2014, who had underwent coronary angiography (CAG) and PCIduring hospitalization. All of the patients were randomly divided intoeptifibatide group (41patients) and non-eptifibatide group (42patients). Allthe patients were admitted to the Standard anticoagulation and antiplatelettherapy treatment of coronary heart disease since they were in hospital:300mg aspirin and300mg clopidogrel for the first time, then100mg aspirin and75mg clopidogrel every day, subcutaneous injection with low molecularheparin and other ancillary medications such as nitrates, ACEI/ARB, statins,β-blocker, CCB and so on. In eptifibatide group, the Intracoronary eptifibatidebolus(180μg/kg) was administered after the lesion was crossed with theguidewire, then followed by an infusion (2μg/kg/min) for18to24h afterprocedure. In non-eptifibatide group were injected with equal physiologicalsaline during PCI.Baseline clinical characteristics, TIMI flow grade, corrected TIMI framecount (CTFC), TIMI myocardial perfusion grade (TMPG), ADP-inducedplatelet aggregation rate, left ventricular ejection fraction (LVEF), bleedingcomplications, the incidence of thrombocytopenia, the difference of MACE ofpatients when7days after PCI were compared between eptifibatide group andnon-eptifibatide group. All data was analysed by SPSS19.0, and P <0.05wasconsidered statistically significant.Results:1In eptifibatide group (41patients), there were16patients diagnosedwith non-ST segment elevation myocardial infarction. In non-eptifibatidegroup(42patients),14patients were diagnosed with NSTEMI. There was nosignificant difference in the proportion of NSTEMI patients between the twogroups.(P＞0.05)2Comparison of basicline clinical characteristics: There was no significant difference between the two groups in age, gender distribution,weight, history of smoking, history of drinking, family history, hypertension,diabetes, hyperlipidemia, red blood cell count, hemoglobin, platelet count,global registry of acute coronary events (GRACE) score, CRUSADE score,LVEF at admission, angina pectoris attacks, ADP-induced platelet aggregationrate.(all P＞0.05)3Comparison of angiographic and procedural characteristics: Coronaryangiography showed there were no significant difference between the twogroups in the proportion of ischemic-related artery and the percentage of TIMIgrade3. The percentage of TIMI grade3achieved after PCI in eptifibatidegroup was sifnificantly higher than non-eptifibatide group (92.7%vs.76.2%,P=0.039). After PCI the eptifibatide group had a significantly better cTFCcompared with the non-eptifibatide group (23.06±3.7vs.26.39±4.02, P＜0.01).While the percentage of TMPG3after PCI in eptifibatide group was higher,but no significant difference was found in the two groups (90.2%vs.78.6%,P=0.144). The rate of no/slow-reflow were similar between groups (2.4%vs7.1%, P=0.616).4Changes of ADP-induced platelet aggregation rate between the groups:There was no significant difference between the two groups in ADP-inducedplatelet aggregation rate before PCI (53.11±11.76%vs51.94±12.47%;P=0.662). Patients treated with eptifibatide, had a significant reduction inmean platelet aggregation from baseline measured immediately after PCI(3.27±1.64%vs.53.11±11.76%P=0.000), this phenomenon existed until2hours after drug discontinuance (16.61±6.47%vs.53.11±11.76%, P=0.000).Patients not treated with eptifibatide, their ADP-induced platelet aggregationrate were similar among the three time points (baseline, immediately after PCI,18to24h).(P＞0.05).5Comparison of LVEF at30days after PCI: Compared with controlgroup, there were significant raise in LVEF at30days after PCI in eptifibatidegroup (52.51±7.27%vs.49.47±5.18%；P=0.031).6Comparison of bleeding events and incidence of thrombocytopenia: Minor bleeding events occurred in8patients (19.5%) receiving epitifibatide(minor) and in2patients (4.8%) receiving clopidogrel. Patients in epitifibatidegroup had significantly higher rate of minor bleeding events (P=0.048). Nopatient was found TIMI major bleeding in both groups, which was nostatistically significant difference. Thrombocytopenia was not found in bothgroups during hospitalization.7The MACE events in7days and the incidence of cardiac rehospitaliza-tion in30days: In this study, in7days, there was one severe heart failure patient in the eptifibatide group and one case of malignant arrhythmias in the control group. In30days follow-up, there was one cardiac rehospitalization patientin eptifibatide group and three cases of cardiac rehospitalization in the controlgroup. No significant differences were found between two groups.Conclusion:1Intracoronary eptifibatide bolus administration during PCI in patientswith NSTE-ACS can effectively improve coronary blood flow, increase thelevel of myocardial perfusion, significantly enhance cardiac function, andbetter than PCI only.2The administration of eptifibatide reduced periprocedural elevation inplatelet aggregation, without increasing the risk of major bleeding events andMACE.