Early invasive strategy with facilitated PCI [GPIIBIIIa receptor blocker plus half dose fibrinolytic therapy plus PCI] versus primary PCI in acute ST segment slevation myocardial infarction

ABSTRACT

This study was done in El-Hussein and Bab Elsharia University Hospitals. From 2002 till 2004. Patients with ST-segment elevation acute myocardial infarction typically require reperfusion therapy either with fibrinolytic therapy or mechincal reperfusion with PTCA and stent implantation. Seventy patients presents within 12 hours of onset of chest pain with St-segment elevation myocardial infarction Half of the patients [group A] undergo aggressive management with facilitated PCI, half dose streptokinase 750000 IU, plus GP IIb/IIIa blocker Tirofiban in weight adjusted dose Coronary angiography done within 90 minutes of presentation with PCI for the infarct related artery [group A].The other half [group B] undergo coronary angiography within 90 minutes to asses TIMI flow with primary PCI to the infarct related artery. Low dose heparin 60 IU bolus then 7 IU/kg infusion for all patients. Aspirin 150 mg at presentation and then once daily. Clopidogrel 300 mg is given to all patients before the procedure and then 75 mg daily for at least one month. Twenty six patients out of thirty five in group A had an anterior wall MI [74.3%] and nine patients had an inferior wall MI [25.7%]. Twenty five patients out of thirty five in group B had an anterior wall MI [71.4%] and ten patients had an inferior wall MI [28.6%]. TIMI flow before PCI, In group A there was fifteen patients out of thirty five had TIMI three flow [42.9%], six patients had TIMI two flow [17.1%], three patients had TIMI one flow [8.6%], and eleven patients had TIMI O flow [3 1.4%]. In group B there was five patients out of thirty five patients had TIMI three flow [14.3%], nine patients had TIMI two flow [25.7%], four patients had TIMI one flow [11.4%], and seventeen patients had TIMI 0 flow [48.6%]. TIMI flow after PCI, in group A there were thirty one patients out of thirty five had TIMI three flow [88.6%], one patient had TIMI two flow [2.9%], and three patients had TIMI 0 flow [8.6%]. In group B there were twenty nine patients out of thirty five patients had TIMI three flow [82.9%], three patients had TIMI two flow [8.6%], one patient had TIMI one flow [2.9%], and two patients had TIMI 0 flow [5.7%]. During the period of follow up nine patients out of thirty five in group A developed chest pain and underwent coronary angiography total occlusion of the stent was present in four patients, significant [more than 50%] lesion was found in three patients, and insignificant [less than 50%] lesion was found in two patients. Nine patients out of thirty five in group B developed chest pain and underwent coronary angiography, total occlusion of the stent was present in one patient, significant [more than 50%] lesion was found in five patients, and insignificant [less than 50%] lesion was found in three patients. There was no statistically significant difference between the incidences of restenosis in both groups. Two patients out of thirty five in group A had a myocardial reinfarction during the period of follow up [5.7%].One patient out of thirty five in group B had a myocardial reinfarction during the period of follow up [2.9%]. In this study we conclude that facilitation of PCI did not affect the use of predilatation or the decrease the incidence of failed PCI. However it increased the incidence of TIMI 2 or 3 flow and decreased the incidence of TIMI 0 or 1 flow before PCI, as expected these incidences became nearly equal in both groups after PCI