RESUMO
BACKGROUND: The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear. METHODS: In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency department to double-blinded therapy with eptifibatide or placebo for 12 to 24 hours before crossover to open-label eptifibatide. Serial creatine-kinase MB (CK-MB) and quantitative cardiac troponin T levels were collected during the first 24 hours to assess the impact of early platelet glycoprotein IIb/IIIa blockade on infarct size as measured by cardiac markers. RESULTS: Median peak CK-MB (10.3 vs 11.8 ng/mL; P =.71) and peak quantitative cardiac troponin T levels (0.2 vs 0.3 ng/mL; P =.95) were similar between treatment groups, respectively. Median calculated peak CK-MB values (41 vs 40 ng/mL; P =.72) and area under the CK-MB curve measurements (980 vs 764 microg/min/L; P =.68) from curve-fitting analyses that could be performed in 106 of 311 patients were also similar. CONCLUSIONS: In this pilot trial, early administration of eptifibatide in the emergency department did not modulate serologic measurements of infarct size in patients with NSTE ACS.
Assuntos
Trombose Coronária/tratamento farmacológico , Creatina Quinase/sangue , Isoenzimas/sangue , Infarto do Miocárdio/sangue , Peptídeos/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Troponina T/sangue , Idoso , Algoritmos , Arritmias Cardíacas/tratamento farmacológico , Biomarcadores/sangue , Creatina Quinase Forma MB , Creatinina/sangue , Estudos Cross-Over , Método Duplo-Cego , Eletrocardiografia , Eptifibatida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/prevenção & controle , Projetos Piloto , SíndromeRESUMO
Cardiac tamponade is a well recognized complication of acute proximal aortic dissection and is almost uniformly fatal if not immediately diagnosed and surgically treated. Pericardiocentesis has an ill-defined and perhaps deleterious role in the management of this condition. Severe concentric left ventricular hypertrophy and intravascular volume depletion may further impede ventricular filling in a patient with cardiac tamponade. We describe the management of a patient who presented in a confused state with an acute proximal aortic dissection complicated by cardiac tamponade and associated with evidence of left ventricular outflow tract obstruction. In such a patient, aggressive fluid administration and emergency surgery should be the treatment of choice.
