Untitled

Abstract

ABSTRACT:We studied the feasibility, safety, clinical benefit, efficacy and 30 day outcome in 50 patients receiving tirofiban in patients with failed thrombolysis in acute ST elevation myocardial infarction, and compared with 50 patients for age, gender and infarct location, who did not receive rescue treatment for different reasons. Tirofiban resulted in an overall ST segment elevation, resolution, at 240 minutes in 44 patients (88 %). Incidence of major events during hospitalization was higher in control group. One patient (2 %) died in study group against 4(8%) in control group while 4 patients had refractory angina needing early percutaneous coronary intervention as compared to 13 in control group. None reinfarcted as against 4 in control group. Two patients developed congestive heart failure against 8 in control group. However, minor bleeding events (mainly gum) were significantly higher, 9 against 0 in control group. Coronary angiography revealed residual thrombus only in 4 patients treated with tirofiban compared to 13 in controls and surprisingly the number of stents required were less in study group (74 % i.e. 37 patients) against (96 % i.e. 48 patients) in control group. On 30 day follow up no death, congestive heart failure or repeat revascularization procedure was recorded in the study group with significant improvement in left ventricular ejection fraction, while as there were 3 deaths and 4 patients had congestive heart failure in control group INTRODUCTION: Success rate of intravenous thrombolysis is close to 70 %. Therefore stratigies for failed thrombolysis or reocclusion/ reinfarction also need to be planned in advance. Ongoing chest pain, non-resolution of ECG i.e. failure of the elevated ST segment to fall by 50% or more in lead with maximal ST elevation recorded 90 minutes after onset of thrombolysis, hemodynamic or electric instability indicate failure of recanalization. Repeat thrombolysis with the same or other agent is not to be practiced.