Background: Primary coronary angioplasty is at present accepted as the most effective reperfusion treatment strategy of the ST elevation acute myocardial infarction. The optimum approach appears to be combination of the interventional technique (mechanical reperfusion) with aggressive pharmacological treatment aimed at the platelets. Intravenous blockers of the glycoprotein receptors IIb/IIIa together with acetylsalicylic acid have the additive antiaggregant effect and are used more frequently as adjunctive therapy by coronary interventions in patients with acute coronary syndromes and the acute myocardial infarction.
Aim: The assessment of safety and effectiveness of the IIb/IIIa platelet blockers in patients indicated to primary coronary angioplasty.
Methods: Since 1st January 2000 to 30th June 2001 the authors carried out the total of 912 coronary angioplasties in their cathlab, from which in 195 cases (21.4%) the primary angioplasty in acute ST elevation myocardial infarction was conducted. IIb/IIIa blockers were administered in the total of 53 cases (5.1% from the whole amount of coronary angioplasties), in 30 cases (15.4% from the total of 195 patients) of the primary coronary angioplasties, unlike the elective procedures, where these agents were given only in 9 patients (1.5% from the overall number of 621 coronary angioplasties) (p < 0.001). The authors in their work analyse the group of patients treated with primary coronary angioplasty with adjuvant treatment of IIb/IIIa platelet blockers.
Results: In the stated period the IIb/IIIa platelet blockers were given to 30 patients at the age of 60.3 +/- 11.3 on average (70% were men). The most frequent risk factors were smoking, in 18 patients (60%), and hypertension, in 14 patients (40%). At least one coronary stent was implanted in 20 patients (66.7%). Abciximab was administered in 27 cases (90%) and eptifibatid in 5 cases (10%). Solely in 5 cases (16.7%) the agents were administered at least 10 minutes before the intervention and therefore preventively, and in 25 cases (83.3%) the administration was rescue. The reason for preventive administration was in 3 cases determination of the angiographically high-risk coronary artery disease and in 2 cases the thrombosis of another non-infarction related artery. The most frequent reason for the rescue use was in 6 cases (22.2%) slow-flow or no-reflow fenomena even after the mechanical obstacles and in 5 cases (18.5%) that were successfully treated with further dilatation, the acute in-stent thrombosis was observed. The infarct-related artery was most often the left anterior descending coronary artery, namely in 16 cases (54%).
Conclusion: IIb/IIIa platelet blockers in primary coronary angioplasty administered either preventively or as rescue therapy are highly effective, relatively safe and improve the effectiveness of mechanical reperfusion. The total in-hospital mortality of this group of patients was 10%.