An aspiration thrombectomy catheter was used if necessary and, finally, a suitable drug-eluting stent (FDA approved) was employed in the IRA in all patients.Īcetylsalicylic acid, a P2Y12 inhibitor (clopidogrel 75 mg), a high-intensity statin, beta-blocker and an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker were prescribed as per the guidelines. Maintenance IV tirofiban of 0.15 μg/kg/ min for 18 hours was started in both groups after the bolus dose. A bolus dose of tirofiban was given through the guiding catheter in the infarct-related artery (IRA) at 30 seconds in the IC group.
In both groups, a bolus of 25 μg/kg of tirofiban was given immediately after the guidewire crossed the lesion successfully and antegrade flow was restored, aiming to secure maximum concentration of the drug at the culprit lesion site and distal microvascular bed. After securing vascular access through the right femoral or radial arteries, a total of 70–100 IU/kg unfractionated heparin IV bolus was given, then an additional weight-adjusted unfractionated heparin was given to achieve approximately 250 seconds of activated clotting time (ACT). Other exclusion criteria included patients presenting with cardiogenic shock, severe liver or kidney failure, bleeding diathesis, hypersensitivity or thrombocytopaenia with tirofiban, platelets < 150 000 cells/mm 3, active internal bleeding, history of ischaemic or haemorrhagic stroke within the last 30 days, atrioventricular malformation or aneurysm, neoplastic aortic dissection, acute pericarditis, haemorrhagic retinopathy and chronic haemodialysis.īefore the intervention all patients were treated with acetylsalicylic acid (300 mg) and clopidogrel (600 mg). Patients with marked uncontrolled hypertension (≥ 180/110 mmHg), rescue PCI and emergency coronary artery bypass grafting were excluded. The institutional ethics committee approved the study and all patients signed informed consent. We included adult patients between 18 and 75 years with a clinical presentation of STEMI and specific ECG criteria in the form of ST-segment elevation ≥ 1 mm in two or more contiguous leads, except V2 and V3 had to be ≥ 1.5 mm in females, ST-segment elevation ≥ 2.5 mm in males less than 40 years or ≥ 2 mm in males more than 40 years, or the presence of new-onset or presumed new left bundle branch block.
TIMI 2 FLOW PLUS
Patients were recruited to receive 25 μg/kg tirofiban bolus plus a maintenance dose of 0.15 μg/kg/ min infusion either IV (group A: n = 50) or IC (group B: n = 45) for 24 hours. The study evaluated 95 consecutive diabetic patients undergoing primary PCI for STEMI.
TIMI 2 FLOW TRIAL
This trial attempted to assess whether intracoronary (IC) administration of high-dose bolus plus a maintenance-dose infusion of tirofiban would lead to better efficacy and safety and enhance clinical outcomes better than the standard intravenous (IV) bolus-plus-infusion regimen during PCI for diabetic patients with acute STEMI. 9, 10 European guidelines recommend tirofiban use in PCI for bailout situations if there is angiographic evidence of massive thrombus, slow or no reflow, or thrombotic complications. 7, 8Īmerican guidelines recommend tirofiban during PCI in patients with STEMI for high burden of thrombus or patients who received inadequate loading of P2Y12 inhibitors, and in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and high risk. Administration of glycoprotein IIb/IIIa inhibitors (GPI) and many catheter-based strategies have been attempted to overcome this phenomenon. 5, 6 Platelet aggregation into the distal microvasculature or thrombus embolisation immediately after successful intervention impairs microvascular flow. Several consequences, such as no reflow and slow flow, associated with more major adverse cardiac events (MACE), complications and high mortality rates have been observed in patients with DM complicated by acute MI (AMI) and undergoing primary PCI.
Successful recanalisation and patency of the occluded vessels with percutaneous coronary intervention (PCI) or fibrinolytics diminishes the infarction size, saves the function of the ventricle and decreases morbidity and mortality rates. 2Īcute occlusion of the major epicardial coronary artery usually leads to acute ST-segment elevation myocardial infarction (STEMI). Moreover, hyperglycaemia significantly increased the mortality rate of patients with diabetes complicated by myocardial infarction (MI). 1 Previous trials have demonstrated a positive correlation between hyperglycaemia and the occurrence of heart failure, arrhythmia and other complications. Impaired glucose metabolism accelerates the risk of arteriosclerosis and 80% of patients with diabetes mellitus (DM) die from cardiovascular diseases.
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