Article

The Benefits of Platelet Glycoprotein IIb/IIIa Receptor Inhibition During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Drug-Specific or Class Effect?

Journal of the American College of Cardiology (Impact Factor: 16.5). 06/2009; 53(18):1674-6. DOI: 10.1016/j.jacc.2009.02.009
Source: PubMed

ABSTRACT

For patients with ST-segment elevation (acute) myocardial infarction (STEMI), reperfusion with primary percutaneous coronary intervention (PCI) results in excellent short-and long-term outcome, predominantly because of the high rate of restoration of normal flow at the epicardial and myocardial levels (1). Despite its success, primary PCI remains fraught with obstacles because of the high thrombus burden, difficulty in initial assessment of lesion length and vessel size, and consequences of distal embolization of plaque and thrombus. Thus, adjunctive pharmacology has always been an important tool for addressing these challenges. Oral and intravenous platelet inhibitors and intravenous thrombin inhibitors have been used in various combinations to reduce thrombus size and prevent its reaccumulation after successful reperfusion.

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    • "A very recent meta-analysis [12] of 6 randomized trials on STEMI patients involving 2197 patients showed that abciximab did not reduce 30-day mortality (2.2% vs. 2.0%, p = 0.66) or re-infarction (1.2% vs. 1.2%, p = 0.88), nor was there any difference in major bleeding complications (1.3% vs. 1.9%, p = 0.27). Thus, among STEMI patients undergoing primary PCI, similar results between abciximab and small molecules in terms of angiographic, electrocardiographic, and clinical outcome [12] may dictate the selection of the less expensive among these agents [13], especially if a class-effect is present, as quite recently hypothesized [14, 15]. "
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