P3700Intracoronary tenecteplase versus abciximab as adjunctive treatment during primary PCI in acute myocardial infarction of anterior location

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

Download Full-text

Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura

Herz ◽

10.1007/s00059-010-3262-1 ◽

2010 ◽

Vol 35 (1) ◽

pp. 43-49 ◽

Cited By ~ 13

Author(s):

Aleksandar N. Neskovic ◽

Ivan Stankovic ◽

Predrag Milicevic ◽

Aleksandar Aleksic ◽

Alja Vlahovic-Stipac ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Idiopathic Thrombocytopenic Purpura ◽

Primary Pci ◽

Thrombocytopenic Purpura

Download Full-text

Actual Role of Platelet Glycoprotein IIb/IIIa Receptor Inhibitors as Adjunctive Pharmacological Therapy to Primary Angioplasty in Acute Myocardial Infarction: In the Light of Recent Randomized Trials and Observational Studies with Bivalirudin

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401004010135 ◽

2010 ◽

Vol 4 (1) ◽

pp. 135-145 ◽

Cited By ~ 9

Author(s):

Osmar Antonio Centurión

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Unfractionated Heparin ◽

Observational Studies ◽

Randomized Trials ◽

Pharmacological Therapy ◽

Bleeding Complications ◽

Primary Pci ◽

Therapeutic Benefits ◽

Ischemic Complications

Strategies for preventing ischemic complications during percutaneous coronary interventions (PCI) in the setting of acute myocardial infarction (AMI) have focused on the platelet surface-membrane glycoprotein (GP) IIb/IIIa receptor. The platelet GP IIb/IIIa receptor inhibitors, by blocking the final common pathway of platelet aggregation, have become a breakthrough in the management of acute coronary syndromes. Current adjuvant pharmacological therapy of AMI with aspirin, clopidogrel, unfractionated heparin (UH), and platelet GP IIb/IIIa inhibitors provides useful therapeutic benefits. Although the use of more potent antithrombin and antiplatelet agents during PCI in AMI has reduced the rate of ischemic complications, in parallel, the rate of bleeding has increased. Several studies have reported an association between bleeding after PCI and an increase in morbidity and mortality. Therefore, investigational studies have focused in pharmacological agents that would reduce bleeding complications without compromising the rate of major adverse cardiovascular events. Based on the results of several randomized trials, abciximab with UH, aspirin and clopidogrel have become a standard adjunctive therapy with primary PCI for AMI. However, some of the trials were done before the use of stents and the widespread use of thienopyridines. In addition, GP IIb/IIIa inhibitors use have been associated with thrombocytopenia, high rates of bleeding, and the need for transfusions, which increase costs, length of hospital stay, and mortality. On the other hand, in the stent era, bivalirudin, a semi-synthetic direct thrombin inhibitor, has recently been shown to provide similar efficacy with less bleeding compared with unfractionated heparin plus platelet GP IIb/IIIa inhibitors in AMI patients treated with primary PCI. The impressive results of this recent randomized trial and other observational studies make a strong argument for the use of bivalirudin rather than heparin plus GP IIb/IIIa inhibitors for the great majority of patients with AMI treated with primary PCI. However, some controversial results and limitations in the studies with bivalirudin exert some doubts in the future widespread use of this drug.

Download Full-text

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽

10.1161/circ.116.suppl_16.ii_630-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Stanley Chia ◽

O. Christopher Raffel ◽

Faisal Merchant ◽

Frans J Wackers ◽

Fred Senatore ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Troponin I ◽

Troponin T ◽

Coronary Intervention ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Primary Pci ◽

Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

Download Full-text

New Antiplatelet Strategies in the Adjunctive Treatment of Acute Myocardial Infarction

Developments in Cardiovascular Medicine - Textbook of Coronary Thrombosis and Thrombolysis ◽

10.1007/978-0-585-33754-8_30 ◽

2008 ◽

pp. 375-387

Author(s):

Christopher J. Ellis ◽

Harvey D. White

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Adjunctive Treatment

Download Full-text

Morphine use and myocardial reperfusion in patients with acute myocardial infarction treated with primary PCI

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.06.204 ◽

2016 ◽

Vol 221 ◽

pp. 567-571 ◽

Cited By ~ 19

Author(s):

Benedetta Bellandi ◽

Chiara Zocchi ◽

Ioanna Xanthopoulou ◽

Fernando Scudiero ◽

Renato Valenti ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Myocardial Reperfusion ◽

Primary Pci

Download Full-text

P259 Adherence to optimal medical therapy in Asian patients with acute myocardial infarction treated with PCI

European Heart Journal ◽

10.1093/ehjci/ehz872.085 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

T Koh ◽

W Huang ◽

F Gao ◽

J C Allen ◽

C Liman ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Medical Therapy ◽

Risk Group ◽

High Risk Group ◽

Primary Pci ◽

Post Discharge ◽

Asian Patients ◽

Β Blockers

Abstract On Behalf SingCLOUD collaborators Background Notable regional differences have been observed worldwide in clinical characteristics and outcomes in patients experiencing acute myocardial infarction (AMI). Asian patients present younger and report higher adverse outcomes rates compared to Western cohorts. The reasons are multifactorial, but adherence to medication prescription guidelines is one of the modifiable factors. Purpose Our aim was to study the effect of physician adherence to Optimal Medical Therapy (OMT) prescription guidelines on a MACE outcome in a high-risk group of Asian AMI patients over 1 year following percutaneous coronary intervention (PCI). Method Data for this retrospective study was from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD) pilot study involving AMI patients surviving primary PCI at two tertiary centers from 2012 to 2013. Guideline-directed OMT adherence was defined as concurrent prescription of at least one statin plus dual antiplatelet therapy (DAPT – aspirin plus P2Y12-I). Prescription of β-blockers and ACE-i/ARBs was also recorded. Prescription status and MACE (repeat MI, stroke, death) was recorded at discharge, 3, 6 and 9 months, and 1 year following the index discharge. The cumulative effect of OMT adherence at 3, 6, 9 months and 1 year post-discharge was studied by comparing risk of first MACE among patient groups with complete, partial and non-adherence to OMT prescription guidelines. Results 2,478 patients, 80.3% males, mean age 60.3 ± 11.7 years were studied. 1094 (44.1%) underwent primary PCI for STEMI. Single drug prescription at discharge for aspirin, P2Y12-I, and statins was 95, 97 and 95.8%, while prescription of β -blockers and ACE-inhibitors was 86.5 and 75.7%. Prescription of statins and aspirin declined gradually while P2Y12-I fell to 67.9% at 6mo and 47.6% at 1 year. Adherence to OMT declined from 92.3% at discharge to 82.1, 58.5, 56.1 and 40.3% at 3, 6, 9 months and 1 year, respectively. Of 342 (13.8%) occurrences of first MACE, 48.5% occurred within 3mo post-discharge. Complete adherence to OMT upon discharge significantly decreased risk of MACE at 3mo (OR = 0.066; 95% CI: 0.054-0.080; p < 0.001) and 12mo (OR = 0.017; 95% CI: 0.010-0.028; p < 0.001) relative to non-adherence. Conclusion Over the course of a year in this high-risk group of PCI-treated AMI patients, there was a reduction in prescription adherence to the minimally essential OMT. Complete OMT adherence is beneficial in reducing MACE. Interventions targeting reasons for non-adherence are important in improving patient outcomes. Abstract P259 Figure 1 - Medication over 1 year

Download Full-text