scholarly journals The role of intracoronary thrombolysis in selected patients presenting with ST-elevation myocardial infarction: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-10
Author(s):  
Sumita Barua ◽  
Paul Geenty ◽  
Tejas Deshmukh ◽  
Cuneyt Ada ◽  
David Tanous ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Plaque Rupture ◽  
Case Series ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Subsequent Increase ◽  
Intracoronary Thrombolysis ◽  
St Elevation ◽  
Distal Protection

Abstract Background Primary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies. Case summary This series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization. Discussion Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.

Abstract 3008: Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Coronary Intervention The randomized Leipzig Immediate PercutaneouS Coronary Intervention Abciximab i.v. versus i.c. in ST-Elevation Myocardial Infarction Trial (LIPSIAbciximab-STEMI)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Holger Thiele ◽  
Kathrin Schindler ◽  
Josef Friedenberger ◽  
Ingo Eitel ◽  
Georg Fürnau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Bolus Administration ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
St Elevation

Background Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary bolus application of abciximab results in high local drug concentrations and may be more effective than standard intravenous bolus application for reduction of infarct size, no-reflow and improvement in perfusion. Methods Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus administration of abciximab with subsequent 12 hour intravenous infusion. Primary endpoint was infarct size and extent of microvascular obstruction assessed by delayed enhancement magnetic resonance. Secondary endpoints were ST-resolution at 90 minutes, Thrombolysis in Myocardial Infarction (TIMI)-flow and perfusion grade post PCI, and the occurrence of major adverse cardiac events within 30 days. Results The primary endpoint infarct size could be reduced by absolute 7% (17.7% i.c. versus 24.7% i.v., p=0.005). Similarly, the extent of microvascular obstruction was significantly smaller in i.c. patients in comparison to i.v. patients (p=0.02). Myocardial perfusion measured as early ST-segment resolution was significantly improved in i.c. patients with an absolute ST-resolution of 76±23% versus 64±31% (p=0.009). The TIMI flow after PCI was not different between treatment groups (p=0.51), but there was a trend towards an improved perfusion grade (p=0.12). There was a trend towards a higher major adverse cardiac event rate after intravenous versus intracoronary abciximab application (15.6% versus 5.2%, p=0.06; relative risk 3.00; 95% confidence intervals 0.94 –10.80). Conclusions: Intracoronary bolus administration of abciximab is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion in primary PCI. An adequately powered trial for major adverse cardiac event reduction is warranted.

scholarly journals Glycoprotein IIb/IIIa Inhibitors Use and Outcome after Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
J. P. Howard ◽  
D. A. Jones ◽  
S. Gallagher ◽  
K. Rathod ◽  
S. Antoniou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Aims. We investigate the effect of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors on long-term outcomes following percutaneous coronary intervention (PCI) after non-ST elevation myocardial infarction (NSTEMI). Meta-analyses indicate that these agents are associated with improved short-term outcomes. However, many trials were undertaken before the routine use of P2Y12inhibitors. Recent studies yield conflicting results and registry data have suggested that GP IIb/IIIa inhibitors may cause more bleeding than what trials indicate.Methods and Results. This retrospective observational study involves 3047 patients receiving dual-antiplatelet therapy who underwent PCI for NSTEMI. Primary outcome was all-cause mortality. Major adverse cardiac events (MACE) were a secondary outcome. Mean follow-up was 4.6 years. Patients treated with GP IIb/IIIa inhibitors were younger with fewer comorbidities. Although the unadjusted Kaplan-Meier analysis suggested that GP IIb/IIIa inhibitor use was associated with improved outcomes, multivariate analysis (including propensity scoring) showed no benefit for either survival (P=0.136) or MACE (P=0.614). GP IIb/IIIa inhibitor use was associated with an increased risk of major bleeding (P=0.021).Conclusion. Although GP IIb/IIIa inhibitor use appeared to improve outcomes after PCI for NSTEMI, patients who received GP IIb/IIIa inhibitors tended to be at lower risk. After multivariate adjustment we observed no improvement in MACE or survival and an increased risk of major bleeding.

Abstract 324: Real World Use of Bivalirudin in ST-Elevation Myocardial Infarction is Associated with Lower In-Hospital Complications, 1-Year Major Adverse Cardiac Events and Mortality

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Luis M Ortega ◽  
Craig E Strauss ◽  
Ross F Garberich ◽  
Brandon R Porten ◽  
Ivan J Chavez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
Coronary Intervention ◽  
Major Adverse Cardiac Events ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Bleeding Events ◽  
P2y12 Inhibitors ◽  
Adverse Cardiac Events ◽  
St Elevation

Background: Bivalirudin decreased bleeding and improved mortality in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) in the HORIZON trial. Currently there is limited data regarding the benefits of bivalirudin in unselected STEMI patients in real-world clinical practice. Methods: We reviewed consecutive STEMI patients at a large regional STEMI referral center from June 2009 to December 2011. All patients received aspirin and P2Y12 inhibitors. In-hospital complications, length of stay (LOS), total variable costs, 1-year cardiovascular readmissions, major adverse cardiac events (MACE) and mortality were compared for: bivalirudin alone, heparin alone and either medication with IIb/IIIa inhibitors. Results: Among 759 STEMI PCI cases, 208 (27.4%) received bivalirudin, 216 (28.5%) heparin and 335 (44.1%) IIb/IIIa, including only 48 cases with bivalirudin. Bivalirudin alone had significantly lower in-hospital complications, bleeding events, mortality and 1-year MACE and mortality (p<0.05 for all) (Figure). There were no significant differences in LOS (median 2.6 vs. 2.8 vs. 2.9 days; p=0.065), total variable costs (median $9,303 vs. $9,242 vs. $9,860; p=0.15) or readmissions within 1 year. Conclusions: In an unselected population of STEMI patients, those treated with bivalirudin had lower in-hospital complications and lower 1-year MACE and mortality rates compared to patients receiving heparin or IIb/IIIa inhibitors. These results provide further support for bivalirudin use in STEMI patients.

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