Early eptifibatide improves TIMI 3 patency before Early eptifibatide improves TIMI 3 patency before primary PCI for acute STEMI: results of the primary PCI for acute STEMI: results of the

randomized integrilin in acute myocardial infarction randomized integrilin in acute myocardial infarction (INTAMI) pilot trial(INTAMI) pilot trial

Early eptifibatide improves TIMI 3 patency before Early eptifibatide improves TIMI 3 patency before primary PCI for acute STEMI: results of the primary PCI for acute STEMI: results of the

randomized integrilin in acute myocardial infarction randomized integrilin in acute myocardial infarction (INTAMI) pilot trial(INTAMI) pilot trial

INTAMI TrialINTAMI TrialINTAMI TrialINTAMI Trial

European Heart Journal Advance AccessEuropean Heart Journal Advance Access

April 27, 2005 April 27, 2005

Uwe Zeymer, et al. Uwe Zeymer, et al.

www. Clinical trial results.org

Early EptifibatideDouble bolus of 180 µg/kg at 10 min interval, (first bolus mean 45 min before angiography)

then 2.0 μg/kg/min infusion >12-24 hours

n=55

Early EptifibatideDouble bolus of 180 µg/kg at 10 min interval, (first bolus mean 45 min before angiography)

then 2.0 μg/kg/min infusion >12-24 hours

n=55

Endpoints: Primary: Patency of culprit artery before PCI Secondary: Patency of culprit artery after PCI, ST resolution at 60 min

post-PCI, all-cause death, reinfarction, urgent revascularization, stroke, and severe bleeding

Endpoints: Primary: Patency of culprit artery before PCI Secondary: Patency of culprit artery after PCI, ST resolution at 60 min

post-PCI, all-cause death, reinfarction, urgent revascularization, stroke, and severe bleeding

INTAMI TrialINTAMI TrialINTAMI TrialINTAMI Trial

European Heart JournalEuropean Heart Journal

Late or No EptifibatideOptional at time of PCI (86%

received eptifibatide) n=51

Late or No EptifibatideOptional at time of PCI (86%

received eptifibatide) n=51

102 patients with STEMI scheduled for primary PCIChest pain <12 hours; PCI w/in 3 hours of admission

All received aspirin (50 mg i.v.) and heparin (5.000 U i.v., then 1.000 U/h)Fibrinolytic therapy w/in 24 hours excluded

102 patients with STEMI scheduled for primary PCIChest pain <12 hours; PCI w/in 3 hours of admission

All received aspirin (50 mg i.v.) and heparin (5.000 U i.v., then 1.000 U/h)Fibrinolytic therapy w/in 24 hours excluded

www. Clinical trial results.org

INTAMI Trial: Primary endpointINTAMI Trial: Primary endpointINTAMI Trial: Primary endpointINTAMI Trial: Primary endpoint

34.0%

10.2%

0%

5%

10%

15%

20%

25%

30%

35%

Early Late or No

34.0%

10.2%

0%

5%

10%

15%

20%

25%

30%

35%

Early Late or No

• Early eptifibatide administration was significantly associated with a greater frequency of TIMI 3 flow in the infarct-related artery before PCI.

• Similarly, incidence of TIMI myocardial perfusion grade 3 before PCI was significantly higher in the early treatment group (p=0.01).

• There were no differences in the two treatment arms in TIMI 3 flow after PCI, ST segment resolution, or 30-day clinical endpoints including death, reinfarction, stroke, and major bleeding.

TIMI 3 Flow in Culprit Artery Pre-PCIp = 0.01

European Heart JournalEuropean Heart Journal

www. Clinical trial results.org

INTAMI Trial: SummaryINTAMI Trial: SummaryINTAMI Trial: SummaryINTAMI Trial: Summary

• Among patients with ST-elevation myocardial infarction, those treated with eptifibatide at the time of hospital admittance had significantly higher incidence of TIMI grade 3 flow before PCI than patients treated with optional eptifibatide at the time of PCI

• Incidence of TIMI 3 myocardial perfusion before PCI was also significantly higher in the early eptifibatide group than in the late or no eptifibatide group

• There were no significant differences in any of the secondary endpoints examined, including post-PCI TIMI flow grade, ST segment resolution 1 hr post-PCI, and 30-day death, reinfarction, stroke, and major bleeding.

• This was the first randomized study to evaluate the effects of early administration of eptifibatide on culprit artery patency before PCI. A larger trial is necessary to determine the clinical efficacy and safety of early eptifibatide treatment

• Among patients with ST-elevation myocardial infarction, those treated with eptifibatide at the time of hospital admittance had significantly higher incidence of TIMI grade 3 flow before PCI than patients treated with optional eptifibatide at the time of PCI

• Incidence of TIMI 3 myocardial perfusion before PCI was also significantly higher in the early eptifibatide group than in the late or no eptifibatide group

• There were no significant differences in any of the secondary endpoints examined, including post-PCI TIMI flow grade, ST segment resolution 1 hr post-PCI, and 30-day death, reinfarction, stroke, and major bleeding.

• This was the first randomized study to evaluate the effects of early administration of eptifibatide on culprit artery patency before PCI. A larger trial is necessary to determine the clinical efficacy and safety of early eptifibatide treatment