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(Chest. 2004;126:935-941.)
© 2004 American College of Chest Physicians

Prehospital Therapy With the Platelet Glycoprotein IIb/IIIa Inhibitor Eptifibatide in Patients With Suspected Acute Coronary Syndromes*

The Bochum Feasibility Study

Christoph Hanefeld, MD; Clemens Sirtl, MD; Martin Spiecker, MD; Waldemar Bojara, MD; Peter H. Grewe, MD; Thomas Lawo, MD and Andreas Mügge, MD

* From the Department of Cardiology & Angiology (Drs. Hanefeld, Spiecker, Bojara, Grewe, Lawo, and Mügge), St. Josef-Hospital/Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum, Germany; the Department of Anaesthesiology (Dr. Sirtl), St. Josef-Hospital, University Hospitals of the Ruhr-University Bochum, Bochum, Germany.

Correspondence to: Andreas Mügge, MD, Medical Clinic II (Cardiology & Angiology), St. Josef-Hospital/Berufsgenossenschaftliche Kliniken Bergmannsheil, University Hospitals of the Ruhr-University, Gudrunstrasse 56, D-44791 Bochum, Germany; e-mail: andreas.muegge{at}rub.de

Abstract

Study objectives: To assess the practical application and safety of prehospital antithrombotic therapy with the glycoprotein (GP) IIb/IIIa inhibitor eptifibatide for patients with suspected acute coronary syndrome (ACS) or myocardial infarction (MI).

Design: Open-labeled pilot study. Patients with typical chest pain who were seen within 6 h of the onset of symptoms were enrolled in the mobile emergency ambulance. Patients were stratified by even/uneven days to receive standard treatment or standard treatment plus an IV bolus of eptifibatide (180 µg/kg body weight) followed by a continuous eptifibatide infusion (2 µg/kg/min). The main outcome measurement was a combination of prehospital or in-hospital death, reinfarction, revascularization of target vessels, and major bleeding complications.

Results: A total of 356 patients (age range, 29 to 75 years; women, 24.7%) were included in the analysis. On admission to the hospital, the diagnosis of ACS or MI was confirmed in approximately 60% of patients, and alternative diagnoses were made in 40% of patients. The rates of complications, including fatal and nonfatal complications occurring during transportation and during subsequent hospitalization, were similar in both study groups. The primary end point occurred in 11.8% of patients in the control group, and in 9.6% of those in the eptifibatide group (difference not significant).

Conclusion: The prehospital administration of the GP IIb/IIIa inhibitor eptifibatide is feasible and safe in patients with clinically suspected ACS and MI. The benefit of this treatment has yet to be established in a large-scale multicenter study.

Key Words: acute coronary syndrome • eptifibatide • glycoprotein IIb/IIIa inhibitor • myocardial infarction • primary percutaneous coronary intervention






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