Comparison between intracoronary abciximab and intravenous eptifibatide administration during primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction

Administration of glycoprotein 2b/3a inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention [PPCI] for ST-segment elevation myocardial infarction [STEMI]. Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab [0.25 microg/kg] bolus or two boluses of intravenous Eptifibatide [0.180 microg/kg] each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution [STR], and post-procedural thrombolysis in myocardial infarction [TIMI] grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect [arrhythmia] and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.61]. The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI [micromol/L/hr], was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 [interquartile range [IQR], 3006.0 to 11112.0] versus 7,294 [IQR, 3795.5 to 11803.5]; p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.87]. No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI

[Prevalence of Clopidogrel resistance in patients candidate for percutaneous coronary intervention]

In patients who undergo coronary angioplasty, Clopidogrel resistance is accompanied with increased risk of cardiovascular events [unstable angina, recurrent MI, death, etc]. In different studies resistance to Clopidogrel has been reported to be up to 30%. Identification of these patients and determining the contributing factors can help us to reduce cardiovascular events. This cross-sectional study was carried out on candidates of elective percutaneous coronary intervention [PCI] in Shahid Modarres Hospital. Resistance to Clopidogrel was evaluated by platelet aggregometry in platelet-rich-plasma [PRP] using a routine aggregometer [Helena Biosciences Europe]. The platelet aggregation was measured before and after exposure to 20 micro mol ADP as a reagent. Contributing factors such as age, gender, metabolic factors and medications were examined by Chi-square test. This study was run on 90 candidates for elective PCI. Their mean age was 62.6 +/- 10.2 years and 52.2% were male. 20% were semi-responder and 7.8% was non-responder. Gender, hypertension, obesity, using angiotensin-converting enzyme inhibitors and calcium channel blockers did not have any role in Clopidogrel resistance, but diabetes, hyperlipidemia, using beta blockers and statins were more common in Clopidogrel resistant patients [p<0.005]. Considering both non-responders and semi-responders, prevalence of resistance to Clopidogrel was 27.8%, so we must be worried about it. Further larger studies should be designed to determine and manage the contributing factors

combined approach to severe multi-organ atherosclerosis

Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation is, therefore, of clinical relevance. We herein describe a case of coronary artery disease treated with surgical revascularization using the internal mammary artery and thereafter the progressive atherosclerotic disease of the native coronary arteries as well as the left subclavian and left renal arteries. We also describe and discuss the clinical presentation, the diagnostic procedures, and the therapeutic approach with respect to the percutaneous transluminal angioplasty of the subclavian, renal, and right coronary arteries

Potential role of thermal therapy as an adjunct treatment in congestive heart failure

The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead. Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure

Evaluation of underlying coronary stenosis severity in patients with acute MI after thrombus aspiration using export catheter

Early clinical and retrospective angiographic evaluations indicated that in patients with acute myocardial infarction [MI], vulnerable plaques most often represented a mild luminal stenosis. More recent studies drawing upon prospective angiograms, however, have demonstrated that in majority of patients with acute MI, the underlying stenosis is significant. Twenty-eight patients with acute MI candidated for thrombectomy were enrolled in this study. Thrombectomy was performed using export thrombectomy catheters. After the injection of nitroglycerin, the severity of the lesions was determined by two independent operators. Between April 2007 and February 2008, 28 patients, comprised of 26 men and 2 women with acute MI, were evaluated, The underlying stenosis was >/= 50% in 22 [78.6%] patients and <50% in the remaining 6 [20.4%] patients [P value < 0.01]. The right coronary artery was the most common vessel involved in the lesions < 50%. Contrary to the general belief of many cardiologists, the majority cases of myocardial infarction occur in consequence of significant stenosis

Coronary artery perforation after guidewire removal

Coronary artery perforation is a rare, but potentially serious, complication of percutaneous coronary intervention and is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Management is different but requires prompt recognition and treatment. We describe a case of coronary perforation only after guidewire removal and also review the management of vessel rupture and perforation

Randomized, blinded trial comparing enoxparin with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention

This study was designed to examine a unique and low dose use of intravenous enoxaparin in elective percutaneous coronary intervention [PCI] that would be applicable to an unselected population regardless of age, weight, and renal function. There is limited experience in anticoagulation using intravenous low-molecular-weight heparin in PCI. A total of 100 consecutive patients undergoing elective PCI were treated with a single IV bolus of enoxaparin [0.5mg/kg] in group A of patients [n=50] or with unfractionated heparin in group B of patients [n=50]. Sheaths were removed immediately after the procedure in patients treated with enoxaparin and some hours later in those treated with unfractionated heparin. In group A, ACT was 124.6 +/- 9.3 before PCI and 149.2 +/- 17.1 after that [P<0.05]. In group B, one patient [2.9%] developed groin hematoma. No deaths, MI, or urgent target vessel revascularization were reported. Low- dose [0.5 mg/kg] IV enoxaparin allows a target level of anticoagulation in patients undergoing PCI, appears to be safe and effective, allows immediate sheath removal, and does not require dose adjustment