Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial
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作者:
Gibson, C. Michael
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Gibson, C. Michael
Kirtane, Ajay J.
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Kirtane, Ajay J.
Murphy, Sabina A.
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Murphy, Sabina A.
Rohrbeck, Steve
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Rohrbeck, Steve
Menon, Venu
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Menon, Venu
Lins, Jeffrey
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Lins, Jeffrey
Kazziha, Samer
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Kazziha, Samer
Rokos, Ivan
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Rokos, Ivan
Shammas, Nicolas W.
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Shammas, Nicolas W.
Palabrica, Theresa M.
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Palabrica, Theresa M.
Fish, Polly
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Fish, Polly
McCabe, Carolyn H.
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
McCabe, Carolyn H.
Braunwald, Eugene
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机构:Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
Braunwald, Eugene
机构:
[1] Harvard Univ, Sch Med, TIMI Study Grp, Div Cardiovasc,Brigham & Womens Hosp, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Dept Med, Boston, MA 02115 USA
[3] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
Background Early restoration of epicardial flow before primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has been associated with improved clinical outcomes. Methods We hypothesized that early administration of the glycoprotein IIb/IIIa inhibitor eptifibatide in the emergency department (ED) would yield superior epicardial flow and myocardial perfusion before primary PCI compared with initiating eptifibatide after diagnostic angiography in the cardiac catheterization laboratory (CCL). Three hundred forty-three patients with STEMI were randomized to either early ED eptifibatide (n = 180) or CCL eptifibatide (n = 163). Results The primary end point (pre-PCI corrected TIMI frame count) was significantly lower (faster flow) with early eptifibatide (77.5 +/- 32.2 vs 84.3 +/- 30.7, P = .049). The incidence of normal pre-PCI TIMI myocardial perfusion was increased among patients treated in the ED versus CCL (24% vs 14%, P = .026). There was no excess of TIMI major or minor bleeding among patients treated in the ED versus CCL (6.9% [12/174] vs 7.8% [11/142], P = NS). Conclusion A strategy of early initiation of eptifibatide in the ED before primary PCI for STEMI yields superior pre-PCI TIMI frame counts, reflecting epicardial flow, and superior TIMI myocardial perfusion compared with a strategy of initiating eptifibatide in the CCL without an increase in bleeding risk.