European Heart Journal Advance Access INTAMI Trial Early eptifibatide improves TIMI 3 patency before primary PCI for acute STEMI: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial European Heart Journal Advance Access April 27, 2005 Uwe Zeymer, et al.

INTAMI Trial 102 patients with STEMI scheduled for primary PCI Chest pain <12 hours; PCI w/in 3 hours of admission All received aspirin (50 mg i.v.) and heparin (5.000 U i.v., then 1.000 U/h) Fibrinolytic therapy w/in 24 hours excluded Early Eptifibatide Double bolus of 180 µg/kg at 10 min interval, (first bolus mean 45 min before angiography) then 2.0 μg/kg/min infusion >12-24 hours n=55 Late or No Eptifibatide Optional at time of PCI (86% received eptifibatide) n=51 Endpoints: Primary: Patency of culprit artery before PCI Secondary: Patency of culprit artery after PCI, ST resolution at 60 min post-PCI, all-cause death, reinfarction, urgent revascularization, stroke, and severe bleeding European Heart Journal

INTAMI Trial: Primary endpoint TIMI 3 Flow in Culprit Artery Pre-PCI p = 0.01 Early eptifibatide administration was significantly associated with a greater frequency of TIMI 3 flow in the infarct-related artery before PCI. Similarly, incidence of TIMI myocardial perfusion grade 3 before PCI was significantly higher in the early treatment group (p=0.01). There were no differences in the two treatment arms in TIMI 3 flow after PCI, ST segment resolution, or 30-day clinical endpoints including death, reinfarction, stroke, and major bleeding. European Heart Journal

INTAMI Trial: Summary Among patients with ST-elevation myocardial infarction, those treated with eptifibatide at the time of hospital admittance had significantly higher incidence of TIMI grade 3 flow before PCI than patients treated with optional eptifibatide at the time of PCI Incidence of TIMI 3 myocardial perfusion before PCI was also significantly higher in the early eptifibatide group than in the late or no eptifibatide group There were no significant differences in any of the secondary endpoints examined, including post-PCI TIMI flow grade, ST segment resolution 1 hr post-PCI, and 30-day death, reinfarction, stroke, and major bleeding. This was the first randomized study to evaluate the effects of early administration of eptifibatide on culprit artery patency before PCI. A larger trial is necessary to determine the clinical efficacy and safety of early eptifibatide treatment