1. Prior Studies Linking GP IIbIIIa Inhibition and Improved Myocardial Perfusion
ESPRIT
INTEGRITI
TACTICS
Rate of Increase in DSA
Brightness (Gray /sec)
Index of Absolute Number of 2b3a Receptors Unoccupied
Longer / Earlier Upstream GPIIbIIIa Inhibition Improves Rate of TMPG3 K
Median 67.8K
p = 0.030
P=0.05
Count (in thousands)
51.2  24.8K
Median 54.0K
p = 0.018
Gray per sec
% TMPG 3
Lecture Notes
The results of the angiographic substudy are shown here: Eptifibatide administration improved coronary flow reserve after adenosine compared to placebo from 1.28 to 1.78, p< Coronary flow reserve is the ratio of the velocity of blood flow after adenosine divided by the velocity of blood flow before adenosine. Higher ratios of coronary flow reserve indicate better health of the microvasculature.
The rate of rise in the brightness of the myocardium after adenosine was nearly twice as great for patients receiving eptifibatide: 7.30 vs 3.97 gray per second, p= Likewise, the circumference of the blush tended to growth faster after adenosine. There was no excess in the myocardial staining or TIMI myocardial perfusion grade 1 among eptifibatide treated patients to account for the brighter digital subtraction results in patients treated with eptifibatide.
References
1. Gibson CM, Murphy SA, Hynes C, Marble SJ, Cohen DJ, Cohen E, Lui HK, Kitt MM, Lorenz TJ, and Tcheng JE for the ESPRIT study group. Relationship of CK-MB Release to TIMI Myocardial Perfusion Grade Following Intracoronary Stent Placement: An ESPRIT Substudy. Am Heart J Jan;143(1):
N=27
N=18
n=26
n=21
N = 253
N = 253
Heparin
Heparin + Eptifibatide
Post PCI TMPG 2/3
Post PCI TMPG 0/1
“Upstream”
Duration
(> median)
Gibson CM et al, AJC 2001;87(11):
Gibson CM et al, Circulation. 2004;110:
Gibson. Am J Cardiol. 2004; 94:492-4

2. ESPRIT Substudy: Results Brightness (Gray /sec)
All Patients Have TIMI Grade 3 Flow at Completion of Stenting & Antithrombin Treatment
Coronary Flow Reserve
Rate of Increase in DSA
Brightness (Gray /sec)
Rate of Growth in
Blush Circumference
(cm / sec)
P=0.02
P=0.05
P=0.18
Coronary Flow Reserve
Gray per sec
Circumference (cm)
Lecture Notes
The results of the angiographic substudy are shown here: Eptifibatide administration improved coronary flow reserve after adenosine compared to placebo from 1.28 to 1.78, p< Coronary flow reserve is the ratio of the velocity of blood flow after adenosine divided by the velocity of blood flow before adenosine. Higher ratios of coronary flow reserve indicate better health of the microvasculature.
The rate of rise in the brightness of the myocardium after adenosine was nearly twice as great for patients receiving eptifibatide: 7.30 vs 3.97 gray per second, p= Likewise, the circumference of the blush tended to growth faster after adenosine. There was no excess in the myocardial staining or TIMI myocardial perfusion grade 1 among eptifibatide treated patients to account for the brighter digital subtraction results in patients treated with eptifibatide.
References
1. Gibson CM, Murphy SA, Hynes C, Marble SJ, Cohen DJ, Cohen E, Lui HK, Kitt MM, Lorenz TJ, and Tcheng JE for the ESPRIT study group. Relationship of CK-MB Release to TIMI Myocardial Perfusion Grade Following Intracoronary Stent Placement: An ESPRIT Substudy. Am Heart J Jan;143(1):
N=27
N=16
N=27
N=18
N=32
N=24
Antithrombin
Antithrombin
+ Eptifibatide
Antithrombin
Antithrombin
+ Eptifibatide
Antithrombin
Antithrombin
+ Eptifibatide
Gibson CM et al, Am J Cardiol 2001;87(11):

3. In STEMI Complete Reperfusion (TFG 3, TMPG 3, ST Res  70%) is Associated with a Greater Percent of Receptors Occupied by Integrilin
52.0%
% Pts With Complete Reperfusion
p=0.006
15.4%
13/25
4/22
> 80% Receptors Blocked by Integrilin
< 80% Receptors Blocked by Integrilin
Gibson CM et al, Circulation. 2004;110:

4. Impact of GP IIbIIIa Inhibition on Rate of Rise in Myocardial Contrast ECHO Intensity Following Reperfusion
Kunichika et al, J Am Coll Cardiol 2004;43:276–83.