Efficacy of eptifibatide for treatment of severe dissections following percutaneous transluminal coronary angioplasty (PTCA) in small coronary arteries

It has been shown in several large trials, that the inhibition of glycoprot ein IIb/IIIa receptors of platelets can reduce the rate of ischemic complic ations following percutaneous coronary interventions. We sought to determin e the efficacy of eptifibatide in patients undergoing percutaneous translum inal coronary angioplasty (PTCA) in coronary arteries smaller than 2.5 mm w ho developed severe dissections with or without threatened vessel closure. From April 2000 until April 2001 36 of 693 patients undergoing percutaneous transluminal coronary angioplasty developed severe dissections, in whom ep tifibatide was given as a bail-out procedure in a dosage of a bolus of 180 mug/kg followed by an infusion of 2,0 mug/kg/min over 18 to 24 h. In all bu t two patients it was able to maintain antegrade flow, so that the addition al placement of a coronary artery stent could be avoided. During the intrah ospital stay three patients underwent repeat revascularization (2 Re-PTCAs, 1 ACVB-OP). There were no transmural myocardial infarctions and no death. Conclusion: The results of this prospective trial demonstrate hat eptifibat ide is effective in maintaining antegrade flow in patients presenting with severe dissections or threatened vessel closure following PTCA for symptoma tic coronary artery disease in vessels smaller than 2.5 mm.