Iranian Heart Journal

Iranian Heart Journal

Comparison Between Intracoronary and Intravenous Eptifibatide and Intracoronary Reteplase in Patients Undergoing Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial

Document Type : Original Article

Authors
Salman Nikfarjam
Mostafa Zadkamali
Arsalan Salari
Maryam Shakiba
Mahboubeh Janesar Hoseinie
Fardin Mirbolouk
Cardiovascular Disease Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IR Iran.
Abstract
Background: Despite the benefits of primary percutaneous coronary intervention (PPCI), myocardial perfusion after treatment remains disrupted in some patients. The utility of glycoprotein IIb/IIIa inhibitors and reteplase during the intervention is indeterminate.
Methods: We designed a randomized clinical trial to compare intravenous (IV) and intracoronary (IC) eptifibatide and reteplase in 144 patients with ST-elevation myocardial infarction scheduled for PPCI. The primary outcome was coronary blood flow according to the TIMI flow grade (TFG) before and after PPCI. The secondary outcomes were the differences between ST-segment resolution, diastolic left ventricular dysfunction, left ventricular ejection fraction, mitral regurgitation, CK-MB levels, and hemoglobin levels before and after PPCI.
Results: TFG III was achieved in all patients (100%) in the control and reteplase groups. TFG III was seen in 32 (88.9%) and 33 (91.7%) patients in the IV and IC eptifibatide groups, respectively. TFG II was reported in 4 (11.1%) and 3 (8.3%) patients in the IV and IC eptifibatide groups in the same order. Postprocedural TFG was not significantly different between the groups. There was a significant increase in the CK-MB level in the reteplase group compared with the other groups (P<0.05). Postprocedural hemoglobin, ST resolution, and ejection fraction were not significantly different between the groups. Reteplase was associated with a significant improvement in diastolic left ventricular dysfunction compared with the control group (odds ratio, 0.31; P=0.02). No difference was shown in the development of mitral regurgitation between the 4 groups.
Conclusions: Neither IV nor IC eptifibatide nor reteplase was associated with improvements in the coronary blood flow as determined by TFG, ST resolution, and ejection fraction. (Iranian Heart Journal 2022; 23(1): 6-16)
Keywords
Primary percutaneous coronary intervention
Eptifibatide
Reteplase
Intravenous
Intracoronary
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Iranian Heart Journal
Volume 23, Issue 1
Winter 2022
Pages 6-16