Improving microvascular perfusion with platelet glycoprotein IIb/IIIa receptor inhibition.
The hallmark of acute ST-segment elevation myocardial infarction is complete thrombotic occlusion of the infarct-related artery. Reperfusion strategies over the past 25 years have focused on the early restoration of flow in the epicardial artery. More recently, through enhanced understanding of the microvasculature, the  open artery hypothesis  has moved downstream to also include the complete and early restoration of microvascular flow. Fibrinolytic monotherapy has a ceiling of efficacy, but is universally available. Improvement of early artery patency can be achieved with the addition of a platelet glycoprotein IIb/IIIa receptor antagonist. Mechanical revascularization, via percutaneous coronary intervention, is superior to pharmacologic therapy, but can have limited accessibility. Perhaps the optimal strategy will involve a combination of pharmacologic and mechanical modalities.
Dippel
Eric J
EJ
Cardiovascular Medicine, Genesis Heart Institute, 1236 East Rusholme Street, Suite 300, Davenport, IA 52803, USA. dippel@cvmedpc.com
D000077284:Abciximab; D000800:Angioplasty, Balloon; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab