[Assessment of myocardial reperfusion in patients with acute myocardial infarction treated with combination of fibrinolysis and IIb/IIIa platelet inhibitor].
Facilitated percutaneous coronary intervention (facilitated PCI) in acute myocardial infarction--the use of planned PCI after pharmacological reperfusion therapy, can fuse the best aspects of thrombolysis and primary angioplasty. The aim of the study was to assess microvacular reperfusion in patients with acute myocardial infarction treated with half dose of alteplase and full dose of abciximab followed by primary PCI.


METHODS
The study enrolled 100 patients with myocardial infarction within 12 hrs of chest pain onset in hospitals with at least 90 minutes of transportation time to interventional center. All patients received intravenous boluses of 60 U/kg heparin, 15 mg alteplase (r-tPA) and 0.25 mg/kg abciximab, and then infusions of: alteplase (35 mg/60 min) and abciximab (0.125 micrograms/kg/min for 12 hours) before transportation to interventional facility


RESULTS
Coronary angiography was performed at a mean 123 +/- 38 minutes after lytic therapy administration. In baseline angiography 73% of patients had TIMI 3 flow in infarct related artery. In 88 patients (90%) there was TIMI 2 + 3 flow. In 82 patients PCI was performed immediately after diagnostic catheterization, with angiographic procedural success rate of 92% (TIMI 3). Corrected TIMI frame count was 29.8 +/- 25.9 before and 17.2 +/- 9.5 after PCI. TIMI Myocardial Perfusion Grade 3 and 2 (MPG 3 + 2) was present in 77% of patients before and in 72% after PCI.


CONCLUSIONS
Combination of abciximab and half dose of alteplase was a very effective strategy in restoring flow in infarct related artery and achieving microvascular reperfusion. This model of pharmacological treatment could be utilized as pre-treatment for patients referred for primary PCI from remote hospitals.
Dudek
Dariusz
D
II Klinika Kardiologii Collegium Medicum Uniwersytet Jagielloński, 31-501 Kraków. mcdudek@cyf-kr.edu.pl
Bartuś
Stanisław
S
Zmudka
Krzysztof
K
Kuta
Marcin
M
Legutko
Jacek
J
Wizimirski
Marcin
M
Pieniazek
Piotr
P
Przewłocki
Tadeusz
T
Gajos
Grzegorz
G
Bryniarski
Leszek
L
Dragan
Jacek
J
Pasowicz
Mieczysław
M
Zorkun
Cafer
C
Dubiel
Jacek S
JS
D000208:Acute Disease; D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D010959:Tissue Plasminogen Activator