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Long-term clinical outcomes up to 7- year results of intracoronary stand-alone bolus administration of eptifibatide during coronary intervention (ice) study

Walid Hassan, Karim Fahmy, Mariam Hassan, Sheref Zaghloul, Ehab I Hasan, Khaled Tammam, Atef Ibrahim, Mohamed Thabet, Malik K Malik, Nathem Akhras

Objectives: This study evaluated the immediate, intermediate and 7-year results of intracoronary (IC) eptifibatide administration during percutaneous coronary intervention (PCI). Background: Several studies tested intravenous (IV) bolus and continuous administration of eptifibatide during PCI. However, limited data is available considering giving eptifibatide as IC bolus alone during PCI. Methods: Clinical outcomes of 376 patients who received coronary stent(s) + eptifibatide by three applications during PCI and were followed up for over 84 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 + infusion. The standard two boluses of eptifibatide 180 mcg/kg were given either via IC or IV route and only groups B and C received IV infusion at 2 mcg/kg/min for 18-24 hours. Results: There were 256 males and 120 females, mean age 57 ± 11. Among them 52% were diabetics. The 6, 12, 24, 84-month cumulative composite endpoint of death and myocardial infraction (MI) was lower in group A (2.5%) compared to group C (10.8%, OR 4.3, p = 0.029), and group-B (5.8%, OR 2.6, p = 0.17). Compared to group-A, target vessel revascularization (TVR) was three fold in group-C (OR 3.3, p = 0.001) and two-fold in group-B (OR 2.0, p = 0.061). Bleeding was significantly higher in Group-C (OR 5.4, p < 0.0001) and Group-B (OR 3.4, p = 0.007) compared to Group-A. Re-hospitalization was significantly lower in group A (10.9%) compared to group B (16.8%) and group C (28%) (P =0.0009). 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.