1. In STEMI Complete Reperfusion is Associated with a Greater % of Receptors Occupied by Integrilin
52.0%
Complete Resolution
TFG 3
TMPG 3
ST Resolution  70%
p=0.006
Pts With Complete Reperfusion (%)
Dr Gibson published in Circulation a subanalysis of the INTEGRITY study showing that in pts treated with tenecteplase and eptifibatide, the higher occupancy of the GPIIb/IIIa receptors was associated with improved flow through large and small vessels. Pts with higher occupancy of the GPIIb/IIIa receptor were more likely to achieve complete myocardial reperfusion characterized by TFG 3, TMPG 3 and ST resolution > 70% than pts with lower receptor occupancy. Then, it seems that higher concentrations of the GPIIb/IIIa inhibitors might cause higher RO and improved outcomes, maybe through dethrombosis. If this is true, we should aim for higher concentrations of drug at the coronary level. And how can you do it? By using IC infusion. The IC infusion of eptifibatide may reach concentrations 100 times higher than IV infusion.
15.4%
13/25
4/22
> 80% Receptors Blocked by Integrilin
< 80% Receptors Blocked by Integrilin
Gibson CM et al, Circulation 2004

2. In Vitro Disaggregation Data
At 100 times the usual systemic IV dose eptifibatide disaggregates virtually all clot in vitro.
100 X
IV dose
100
10 X
IV dose 90 80 70 60
IV dose
Disaggregation (%) 50 40 30 20
In this slide we can see that higher concentrations of GPIIb/IIIa are associated with higher dethrombosis meaning disaggregation of clots. A concentration 100 times higher than the one obtained with the usual IV dose of GPIIb/IIIa produces almost complete disaggregation of clots in vitro. 10
µg/ml
0.375 µg/ml
3.76 µg/ml
Moser M, et al. J Cardiovasc Pharmacol
41: , 2003.

3. Clot Disaggregation Following IC Eptifibatide: Pre-PCI Angiogram
Pinto et al, Am J Cardiol 2006

4. Retrospective Experience with IC Eptifibatide
59 patients treated with unbuffered IC eptifibatide:
TIMI Grade 3 flow in >90% of patients following PCI
Normal TIMI myocardial perfusion grade 3 flow (TMPG 3) present in 54.4% of patients following PCI (range 20%-25% in past)
There were no in-hospital deaths, reinfarctions, or TIMI major bleeding events
No arrhythmias during IC eptifibatide administration
Of 59 pts…
Pinto et al. Am J Cardiol 2006

5. IC TITAN - TIMI 47 IntraCoronary Treatment with Integrilin To Improve ANgiographic Outcomes
STEMI for Primary PCI
ASA mg; Clopidogrel mg
UFH; IV eptifibatide (double bolus and infusion)
Baseline Coronary Angiography
Advance wire and balloon
without crossing lesion or withdrawing wire
IC Eptifibatide
90 μg/kg bolus
IC saline
bolus
2 min
2 min
Angiography of culprit artery to assess stenosis, epicardial flow and myocardial perfusion
PCI
Angiography of culprit artery to assess epicardial flow and myocardial perfusion