Immediate and intermediate results of intracoronary stand-alone bolus administration of eptifibatide during coronary intervention (ICE) study

Background This study evaluated the immediate and intermediate results of intracoronary (IC) eptifibatide administration during percutaneous coronary intervention (PCI). Several studies tested intravenous (IV) bolus and continuous administration of eptifibatide during PCI. However, limited data are available regarding giving eptifibatide as IC bolus alone during PCI. Methods We studied clinical outcomes of 376 patients who received coronary stent(s) and eptifibatide by 3 applications during PCI and were followed up over 24 months. Group A (119 patients) had IC eptifibatide bolus only, group B (119 patients) had IC bolus and IV infusion, and group C (138 patients) had IV bolus and infusion. The standard 2 boluses of eptifibatide 180 μg/kg were given either via IC or IV route, and only groups B and C received IV infusion at 2 μcg · kg−1 · min−1 for 18 to 24 hours. Results There were 256 males and 120 females, with a mean age of 57 ± 11 years. Among them, 52% were diabetic. The 6-, 12-, and 24-month cumulative composite end point of death and myocardial infraction was lower in group A (2.5%) compared with group C (10.8%, odds ratio [OR] 4.3, P = .029) and group B (5.8%, OR 2.6, P = .17). Compared with group A, target vessel revascularization was 3-fold in group C (OR 3.3, P = .001) and 2-fold in group B (OR 2.0, P = .061). Bleeding was significantly higher in group C (OR 5.4, P < .0001) and group B (OR 3.4, P = .007) compared with group A. Rehospitalization was significantly lower in group A (10.9%) compared with group B (16.8%) and group C (28%) (P = .0009). Conclusion The IC-bolus-alone application of eptifibatide may be safer and superior to the IV route, and continuous infusion may not be necessary. Large-scale prospective randomized trials are needed to further validate these findings.