Comparison between the effect of intracoronary bolus of tirofiban versus eptifibatide as adjunctive antiplatelet therapy on the outcome of primary coronary intervention in patients with acute anterior ST segment elevation myocardial infarction

Background: Primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been shown to be the preferred reperfusion strategy. Adjunctive GP IIb/IIIa inhibitors improve the outcome in patients with ST-elevation myocardial infarction undergoing primary percutaneous intervention (PCI). Intracoronary (IC) GP IIb/IIIa bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus. It remains unclear which of the two available GP IIb/IIIa inhibitors in Egypt eptifibatide and tirofiban would be of great benefit when used as IC bolus. Methods: Sixty patients with anterior STEMI undergoing primary PCI in Ain Shams University Hospitals were randomized to either intracoronary eptifibatide (Integrilin®) double bolus dose (n= 30) or IC tirofiban (Aggrastat®) high bolus dose (n= 30) with subsequent 12-24. h intravenous infusion of the same GP IIb/IIIa inhibitors. The primary end point was achievement of TIMI III flow and at least MBG II or III. The secondary end points were in hospital occurrence of major adverse cardiac events (MACE) including death, recurrent ischemia and target vessel revascularization, successful ST segment resolution and preservation of systolic function. The safety endpoint was in hospital occurrence of any major or minor bleeding according to TIMI classification. Results: All baseline characteristics including demographics, risk factors, clinical data, time of chest pain, basic ECG data and angiographic data were statistically nonsignificant among both study groups. Regarding primary endpoint: No statistically significant difference in achievement of TIMI III flow, but achievement of MBG II and III indicating successful perfusion was much higher in eptifibatide group (76.6%) than tirofiban group (36.6%) p= 0.005. Regarding secondary end points: No statistically significant difference in rate of in-hospital MACE among both groups with one death (3.3%) in each group, but less recurrent ischemia in eptifibatide group (0%) than tirofiban group (16.7%) p= 0.026., also successful ST segment resolution as indirect sign of successful reperfusion (70.9 ± 11.3 versus 59.7 ± 9) and systolic function preservation (EF of 46.6 ± 5.5 versus 39.9 ± 6) were significantly better in eptifibatide group p< 0.001. Regarding safety end points: There was no difference in TIMI major bleeding among both groups but TIMI minor bleeding had occurred in tirofiban group (33.3%) more than eptifibatide group (0%) p< 0.001. Conclusion: In patient with anterior STEMI treated by primary PCI IC eptifibatide was superior to IC tirofiban in terms of successful perfusion, less recurrent ischemia, more ST segment resolution, and systolic function preservation with less TIMI minor bleeding. © 2011.