Local delivery of GPIIb/IIIa inhibitors versus intracoronary administration via the guiding catheterin ACS patients

Abstract

Acute coronary syndromes are common phenomena nowadays.They are caused by plaque rupture and thrombosis leading to myocardial ischemia. Percutaneous coronary intervention (PCI) is often the primary therapy. Before the era of glycoprotein (GP) IIb/IIIa inhibitors, PCI was associated with a major adverse cardiac event rate of 10% to 12%.The GP IIb/IIIainhibitor eptifibatide has been demonstrated to improve cardiac outcomes among patients with PCI by reducing the occurrence of major adverse cardiac events. Despite this improvement in outcomes, micro-infarcts may still complicate PCI in the absence of angiographically evident vessel obstruction. Thrombus and vascular debris may embolize and lead to plugging of the microvasculature, microvascular dysfunction, and eventually myocardial necrosis. GP IIb/IIIa antagonists at elevated local concentrations may enhance thrombus disaggregation by disrupting platelet crosslinking. Indeed, higher levels of platelet GP IIb/IIIa receptor occupancy with eptifibatide have been associated with improved myocardial perfusion among patients with ST-elevation myocardial infarction. Thus, local administration of eptifibatide may result in much higher local concentration, which may lead to increased levels of platelet GP IIb/IIIa receptor occupancy, destabilization of platelet aggregates, and promotion of thrombus disaggregation in the epicardial artery and microvasculature, possibly offering the potential of improving myocardial perfusion. Eptifibatide has been shown to be safe in intracoronary administration in acute coronary syndromes.