Comparison of reperfusion regimens with or without tirofiban in ST-elevation acute myocardial infarction

Martínez-Ríos, Marco Antonio; Rosas, Martı́n; González, Héctor; Peña‐Duque, Marco Antonio; Martínez‐Sánchez, Carlos; Gaspar, Jorge; García, Heladia; Gaxiola, Efraín; Delgado, Luis; Carrillo, Jorge; Leyva, José-Luis; Lupi, E

doi:10.1016/j.amjcard.2003.10.005

Cited by 31 publications

(16 citation statements)

References 23 publications

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“…The most important result was the safety of this combination. We used also the combination of tirofiban with half dose of thrombolytic agent, in agreement with our and other reports which showed the efficacy of this combination [42][43][44][45] The high dose bolus was not used because this protocol was reported only recently [46]. Our study was not addressed to compare different GP IIb/IIIa inhibitors, but it was performed to evaluate if a delayed interventional strategy after combined treatment in this setting of patients was possible independently of thrombolytic drug and GP IIb/IIIA inhibitor combination.…”

Section: Discussionsupporting

confidence: 87%

“…The risk of 1-year mortality is increased by 7.5% for each 30-minute delay [37]. A combined pharmacoinvasive approach capitalizing on the rapidity of initiation and widespread feasibility of pharmacologic reperfusion to promptly restore at least some myocardial blood flow, coupled with the more complete restoration achievable with subsequent PCI, merits consideration as an optimal approach [38]. The temporal window for efficacy of PCI can be broadened by employing pharmacologic components as part of the pharmacoinvasive recanalization strategies [39,40].…”

Section: Discussionmentioning

confidence: 98%

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Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Pasquale

Cannizzaro

Parrinello

et al. 2006

J Thromb Thrombolysis

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Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI, and that delayed PCI in patients treated with combined lytic and IIb/IIIa inhibitors appears to be as effective and possibly superior (reduced ischemic events and repeat PCI) as immediate PCI. The patients in this study were successfully reperfused, with TIMI-3 flow and our data may not apply to patients with TIMI 0-2 flow. This strategy could allow transferring the reperfused patients and performing PCI after hours < 72 hours and not immediately, thereby reducing the number of urgent PCI and costs, obtaining similar results, but mostly causing less discomfort to the patient. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies. The study was aimed to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 h, and in patients initially successfully treated with pharmacological therapy and delayed PCI (12-72 h). All patients had to have successful reperfusion, to receive the combination of a standard abciximab or tirofiban infusion plus half dose rtPA. Similar results were observed in both groups. Delayed PCI group showed a significant lower incidence in restenosis (0.01), minor bleedings (0.005), ischemic events (0.01) and a reduced angiographic evidence of thrombus formation in IRA (0.001). Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Pasquale

Cannizzaro

Parrinello

et al. 2006

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…The percentage of patients with NR according to the accepted triaging is comparable with previously published data [20]. However, another study revealed the percentage of patients with TMP grade 0 or 1 after primary angioplasty to be only 15%, even though nondiabetic patients were included [21]. These findings are in agreement with previous observations suggesting that diabetics with a final-flow TMP grade >1 are less frequent than in a diabetes-free cohort [22].…”

Section: Discussionsupporting

confidence: 83%

Aspirin ‘Resistance': Impact on No-Reflow, Platelet and Inflammatory Biomarkers in Diabetics after ST-Segment Elevation Myocardial Infarction

et al. 2015

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Background: The no-reflow (NR) phenomenon exists despite percutaneous coronary intervention (PCI), and is especially prevalent in diabetics. The causes(s) of NR are not fully elucidated, but may be associated with impaired residual platelet and inflammatory reactivity during dual-antiplatelet therapy. Objective: To assess the relationship between dual-antiplatelet therapy, NR and conventional biomarkers suggestive of platelet and inflammatory response in diabetics following ST-segment elevation myocardial infarction (STEMI) treated with PCI. Methods: Sixty diabetics with (n = 27) and without NR (n = 33) were prospectively enrolled. All patients were treated with clopidogrel and aspirin. Platelet and inflammatory biomarkers were assessed serially in the peripheral blood and right atrium before and after PCI and then at 24 h, 7 days and 30 days. Results: Arachidonic acid (AA)-induced platelet aggregation and the serum thromboxane B₂ level before and after PCI (in the peripheral and right atrium blood) were significantly higher in the NR patients than in those with no NR. AA-induced aggregation >100 (AUC*min) before PCI predicted NR in diabetic patients with 96.2% sensitivity and 38.5% specificity (AUC 0.66; 95% CI 0.52-0.71; p = 0.029). There were no other correlations between NR and platelet reactivity (collagen, adenosine diphosphate, thrombin receptor agonist peptide-induced aggregation, vasodilator-stimulated phosphoprotein platelet reactivity index, soluble P-selectin, soluble CD40 ligand, platelet-derived growth factor AB and the level of platelet-monocyte aggregates) or between NR and inflammatory indices (i.e. high-sensitivity C-reactive protein, interleukin 6 and interleukin 10). Conclusion: An inadequate response to aspirin, but not to clopidogrel, may be associated with the occurrence of the NR phenomenon in diabetics with STEMI who have been treated with primary PCI.

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“…Especially the first meta-analysis published in 2004 [27] consists of trials with both abciximab and tirofiban in combination with primary PCI. Some other smaller studies support the value of tirofiban in ST-elevation myocardial infarction [30][31][32]. In another smaller study primary PCI with eptifibatide revealed similar results as with abciximab [33].…”

Section: Discussionmentioning

confidence: 63%

Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: Results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial

Peters¹,

Truemmel²,

Koehler³

2008

International Journal of Cardiology

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Comparison of reperfusion regimens with or without tirofiban in ST-elevation acute myocardial infarction

Cited by 31 publications

References 23 publications

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Aspirin ‘Resistance': Impact on No-Reflow, Platelet and Inflammatory Biomarkers in Diabetics after ST-Segment Elevation Myocardial Infarction

Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: Results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial

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