Adjunctive therapies in the cath lab. Combination of tirofiban and alteplase in acute myocardial infarction.

Primary angioplasty results in higher reperfusion rates than fibrinolysis in patients with acute myocardial infarction (MI). Two recent trials have shown improved rates of reperfusion when a reduced-dose thrombolytic is combined with the platelet glycoprotein IIb/IIIa receptor inhibitor abciximab. We present a case report of acute MI successfully treated with a combination of tirofiban and half-dose alteplase and eventual percutaneous coronary intervention.

Myocardial bridging of left circumflex coronary artery associated with acute myocardial infarction.

Myocardial bridging of coronary arteries has been associated with myocardial infarction (MI), conduction disturbances, and sudden cardiac death. There are several reports on MI in association with myocardial bridging of the left anterior descending coronary artery. Here we present a case report of acute MI associated with myocardial bridging of the left circumflex coronary artery.

Acute left anterior descending artery occlusion in a hemophiliac A patient during recombinant factor VIII infusion: treatment with coronary angioplasty.

Acute myocardial infarction in association with the replacement of recombinant factor VIII in hemophiliacs has not been documented. We describe the use of PTCA in a hemophiliac A patient who developed acute myocardial infarction during factor VIII replacement. Because surgery in hemophiliac A patients remains hazardous, PTCA seems to be an attractive alternative.

Combination of abciximab with primary stenting in patients with acute myocardial infarction: a community hospital experience.

Abciximab administration during primary coronary angioplasty in patients with acute myocardial infarction (AMI) reduces death, reinfarction, and the need for urgent target vessel revascularization (TVR). Stenting in AMI reduces the rate of repeat in-hospital TVR. There is limited information on the effectiveness and one-year clinical event rate of combined abciximab and primary stenting in patients with AMI at community hospitals. We evaluated the outcome of 40 consecutive patients treated with both abciximab and primary stenting at our institution. All patients underwent primary stenting of the infarct-related artery. All patients received abciximab, aspirin, ticlopidine, and heparin. TIMI grade 3 flow was established in all 40 patients. No patient required urgent TVR. There was no in-hospital reinfarction or cardiac-related death. All patients were followed for at least one year, and no patient died after hospital discharge. Thallium exercise stress test revealed no evidence of ischemia at 12 months follow-up. We conclude that combined abciximab and primary stenting in this series of patients with AMI was associated with excellent results.

Hepatocellular injury in a patient receiving rosiglitazone. A case report.

BACKGROUND: Rosiglitazone maleate (Avandia, SmithKline Beecham, Philadelphia, Pennsylvania) is a new oral hypoglycemic agent approved for the treatment of type 2 diabetes. It acts primarily by increasing insulin sensitivity. In controlled trials, there has been no evidence of rosiglitazone-induced hepatocellular injury. OBJECTIVE: To report a case of hepatocellular injury in a patient receiving rosiglitazone. DESIGN: Case report. SETTING: Community teaching hospital. PATIENT: 61-year-old man receiving rosiglitazone, 4 mg/d for 2 weeks. INTERVENTION: Discontinuation of rosiglitazone therapy. MEASUREMENTS: Clinical evaluation and assessment of liver function test results were done daily during hospitalization and periodically after discharge. The outpatient record was also reviewed. RESULTS: After receiving rosiglitazone for 2 weeks, the patient presented with anorexia, vomiting, and abdominal pain. Liver function tests revealed severe hepatocellular injury. Discontinuation of rosiglitazone therapy led to rapid improvement of liver function and resolution of symptoms. CONCLUSION: Rosiglitazone may be associated with hepatocellular injury. We believe that patients receiving rosiglitazone should have liver enzyme levels monitored earlier and more frequently than initially recommended.

Abciximab readministration: A single-operator community-hospital experience.

Abciximab, a monoclonal antibody to the platelet glycoprotein IIb/IIIa receptor, reduces ischemic complications of coronary interventions after first administration. In this study, We sought to determine whether readministration of abciximab is associated with equal efficacy and safety. We retrospectively reviewed the charts of 35 patients who received two doses of abciximab at separate intervals. We monitored patients clinically for recurrent ischemia, bleeding complications, and thrombocytopenia. We measured hemoglobin and platelet counts before and after readministration of abciximab. There was no cardiac-related death, myocardial infarction, or recurrent ischemia. No obvious bleeding occurred in any of the 35 patients, although 1 patient had a drop of hemoglobin >3 gm/dl. We observed one episode of severe thrombocytopenia without any complication, and this patient improved without requiring platelet transfusion. There was no profound thrombocytopenia. We conclude that readministration of abciximab was well tolerated without any evidence of altered efficacy or safety. Cathet. Cardiovasc. Intervent. 47:294-296, 1999.

Normal electrocardiogram with total occlusion of the left anterior descending coronary artery.

Total occlusion of the left anterior descending coronary artery is usually characterized by ST-segment elevation in the anterior leads of the surface electrocardiogram. We report a case of a patient who had a persistently normal electrocardiogram throughout his hospitalization despite the angiographic findings of total occlusion of the left anterior descending coronary artery and no collateral vessels. Percutaneous transluminal coronary angioplasty with stent placement was performed successfully.