J Thromb Thrombolysis (2006) 22:47–50 DOI 10.1007/s11239-006-7454-8 Intracoronary bolus administration of eptiﬁbatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina Albert J. Deibele · Ajay J. Kirtane · Duane S. Pinto · Michael J. Lucca · Cathy Neva · Amy Shui · Sabina A. Murphy · James E. Tcheng · C. Michael Gibson C  Springer Science + Business Media, LLC 2006 Abstract Background: Distal embolization of thrombotic debris may occur during and after percutaneous coronary intervention (PCI) for acute coronary syndromes. This may lead to impaired microvascular perfusion, myocardial infarc- tion and increased morbidity and mortality. In vitro stud- ies suggest that high local concentrations of a glycoprotein IIb/IIIa inhibitor may be effective in disaggregating thrombus and thereby prevent microvascular compromise. We hypoth- esized that intracoronary (IC) administration of eptiﬁbatide during stent implantation for unstable angina/non ST ele- vation myocardial infarction (UA/NSTEMI) would be safe and would lead to an acceptable rate of normal myocardial perfusion. Methods: In 54 patients with UA/NSTEMI, 2 boluses of 180 mcg/kg of eptiﬁbatide each were administered via the IC route during PCI. Data were retrospectively collected and reviewed by an independent core laboratory. Results: No adverse events including arrhythmias oc- curred during IC administration of eptiﬁbatide. There were no deaths or urgent revascularizations among patients treated with IC eptiﬁbatide. One patient (2.0%) sustained a post- procedure myocardial infarction. One patient sustained a A. J. Deibele · M. J. Lucca · C. Neva Duluth Clinic, Division of Cardiology, Duluth Minnesota A. J. Kirtane · D. S. Pinto · A. Shui · S. A. Murphy · C. M. Gibson Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, Massachusetts J. E. Tcheng Duke University Medical Center, Division of Cardiology, Durham, North Carolina C. M. Gibson () 350 Longwood Avenue, First Floor Boston, MA 02115 e-mail: mgibson@perfuse.org TIMI major bleeding event due to a gastrointestinal bleed. There were no TIMI minor bleeding events. Normal post PCI TIMI Myocardial Perfusion Grade was observed in 54% of patients. Conclusion: IC bolus administration of eptiﬁbatide was feasible and safe among patients with UA/NSTEMI. Larger prospective and randomized studies are warranted to further explore the efﬁcacy of this strategy. Abbreviated Abstract Intracoronary eptiﬁbatide adminis- tration during PCI for UA/NSTEMI is feasible and safe. Keywords Non ST elevation myocardial infarction . Unstable angina . Glycoprotein IIb/IIIa receptor inhibitor . Intracoronary Introduction Acute coronary syndromes, unstable angina/non ST eleva- tion myocardial infarction (UA/NSTEMI), are caused by atherosclerotic plaque rupture and thrombosis. Urgent or elective percutaneous coronary intervention (PCI) is often a primary therapy. Prior to the era of glycoprotein IIb/IIIa inhibitors, PCI was associated with a major adverse car- diac event rate of 10–12% [1–4]. The glycoprotein IIb/IIIa antagonist, eptiﬁbatide, has been demonstrated to improve outcomes among patients with PCI by reducing the occur- rence of major adverse cardiac events [1]. Despite this im- provement in outcomes, myocardial infarction may still com- plicate PCI in the absence of angiographically-evident com- plications. Thrombus, as well as vascular debris, may embolize leading to plugging of the microvasculature, microvascular dysfunction and myocardial necrosis. Glycoprotein IIb/IIIa Springer