In the most recent ACC/AHA guidelines, the adjunctive use of GPIs at the time of PCI can be considered on an individual basis for large thrombus burden or inadequate P2Y12 receptor antagonist loading

In the most recent ACC/AHA guidelines, the adjunctive use of GPIs at the time of PCI can be considered on an individual basis for large thrombus burden or inadequate P2Y12 receptor antagonist loading.5 Randomized studies have resulted with conflicting results concerning the use of GPIs in the setting of Calcipotriol monohydrate acute myocardial infarction. 95% CI 0.570.96) follow up. Moreover, tirofiban group had a significantly lower 30-day all-cause mortality (secondary end point; OR 0.63, 95% CI 0.400.90), compared with patients who were not administered tirofiban. At 1 year, a trend towards a lower all-cause mortality was observed in the tirofiban group (OR 0.74, 95% CI 0.531.04). No differences were found with respect to the TIMI major bleeding during the follow-up period. == Conclusions: == Tirofiban administered with PPCI, following 600 mg clopidogrel pretreatment, improved primary efficacy outcome at 30 days and at 1 year follow up without an increase in major bleeding. Keywords:Efficacy outcome, glycoprotein IIb/IIIa inhibitor, primary PCI == Introduction == Primary percutaneous coronary intervention (PPCI) with stent implantation is currently considered the preferred treatment option for patients with ST-segment elevation myocardial infarction (STEMI).1However, stent thrombosis remains an important cause of death after PPCI.2Patients at Calcipotriol monohydrate higher risk for stent thrombosis following PPCI might benefit from more aggressive antiplatelet treatment. Neuman et al.3have shown that the level of platelet glycoprotein (GP) IIb/IIIa expression was an independent predictor of stent thrombosis. According to the European Society of Cardiology guidelines,4the use of GP IIb/IIIa inhibitors (GPIs) is reasonable as bailout therapy in the event of angiographic evidence of large thrombus, slow or no reflow, and other thrombotic complications. In the most Calcipotriol monohydrate recent ACC/AHA guidelines, the adjunctive use of GPIs at the time of PCI can be considered on an individual basis for large thrombus burden or inadequate P2Y12 receptor antagonist loading.5 Randomized studies have resulted with conflicting results concerning the use of GPIs in the setting of acute myocardial infarction. Earlier trials showed the reduced risk of 30-day composite end point of death, recurrent myocardial infarction and urgent revascularization, improved ST-segment resolution, and reduced infarction zone during 30-day and 6-month follow up, without an increase in major bleeding.611In addition, abciximab has been shown to improve microvascular flow and ventricular function.1214However, there has not been universal agreement about the importance of GPIs with PPCI in the era of 600 mg clopidogrel loading dose. Some authors showed a lower rate of the Rabbit Polyclonal to SGCA composite of death, recurrent MI, urgent TVR, and bleeding in the GPI arm, mainly driven by less target vessel revascularization and stent thrombosis.15,16However, other randomized PPCI trials did not show benefit of GPI in reducing major adverse cardiac outcomes, rate of stent thrombosis, early or late death, infarction size, or pre-PCI coronary flow.1722 We therefore sought to investigate the short- and long-term efficacy and safety of the periprocedural administration of tirofiban in a large Serbian PPCI centre. == Methods == == Patient selection and management == We analysed data of 2995 consecutive patients registered in the prospective Clinical Center of Serbia STEMI Register between February 2007 and March 2012. The objective of the register was to gather complete and representative data on the management and short- and long-term outcome of patients with STEMI admitted to coronary unit after undergoing primary PCI in our centre. All patients for whom data were entered into the register have received written information of their participation in the registry and the long-term follow up, and their verbal consent for enrolment was obtained. All consecutive patients aged 18 or older, who presented with clinical and electrocardiographic signs of acute STEMI within 12 h after the onset of symptoms were included in the register. For the present analyses, we did not include patients who had contraindications for the use of GPIs (active internal bleeding, known bleeding diathesis, intracerebral mass, or aneurysm) and patients with cardiogenic shock at admission or patients with noncardiac conditions that could interfere with compliance with the protocol or require interruption of thienopyridine treatment. The study protocol was approved by a local research ethics committee. Primary PCI was performed via the femoral approach, using standard 6F or 7F guiding catheters. Before PPCI, 300 mg aspirin and 600 mg clopidogrel were administered. Unfractionated heparin was started as 100 IU/kg bolus; the 12 U/kg/h infusion followed if clinically indicated (atrial fibrillation, left ventricular thrombus or aneurysm, recent or recurrent venous thromboembolism, deferred sheath removal). Proton-pump inhibitor pantoprazol 40 mg or H2-blocker ranitidine 50 mg were given intravenously to all patients before PPCI; a peroral treatment followed in selected patients at risk of gastrointestinal haemorrhage. GPI tirofiban was administered during the procedure in the catheterization laboratory at.