The Quest for Optimal Reperfusion Therapy Continues

Optimal myocardial reperfusion is a well-recognized contributor to lower mortality rates after PCI for ST-elevation myocardial infarction (STEMI). Manual thrombus aspiration and intravenous (IV) administration of glycoprotein IIb/IIa receptor inhibitors (GPIs) improves myocardial reperfusion and clinical outcomes. Recently, observational and prospective studies demonstrated that intracoronary (IC) administration of GPI was associated with better myocardial reperfusion than IV administration in STEMI patients, suggesting that a higher local drug concentration of GPI could further improve clinical outcomes.

Chen et al, authors of the SUIT-AMI trial in this month’s Journal of Invasive Cardiology, took this idea one step further and hypothesized that selective infarct-related artery (sIRA) infusion of GPI (tirofiban) through aspiration catheter might further improve myocardial reperfusion without increasing bleeding compared to IC administration through guiding catheter in STEMI patients undergoing primary angioplasty. Chen et al discovered that — although bleeding rates were not increased — sIRA infusion of tirofiban did not improve myocardial reperfusion assessed by CTFC.

Chen Y, Zhou P, Yan H, Zhao H, Song L, Liu C, Zhao B, Chi Y, Wang S, Wang J. Impact of Selective Infarct-Related Artery Infusion of Tirofiban on Myocardial Reperfusion and Bleeding Complications in Patients With Acute Myocardial Infarction: The SUIT-AMI Trial.  J Invasive Cardiol. 2013 Aug;25(8):376-82.

A selection of myocardial reperfusion related articles is below:

Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction.

Waldo SW, Armstrong EJ, Kulkarni A, Hoffmayer KS, Hsue P, Ganz P, McCabe JM.     J Invasive Cardiol. 2013 Aug;25(8):371-5.

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Impact of preprocedural TIMI flow on myocardial perfusion, distal embolization and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb/IIIa inhibitors.

Maioli M, Zeymer U, van ‘t Hof AW, Gibson CM, Dudek D, Bellandi F, Noc M, Secco GG, Zorman S, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, Huber K, De Luca G; EGYPT Cooperation.  J Invasive Cardiol. 2012 Jul;24(7):324-7.

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Impact of chronic total coronary occlusion on microvascular reperfusion in patients with a first anterior ST-segment elevation myocardial infarction.

Suzuki M, Enomoto D, Mizobuchi T, Kazatani Y, Honda K.  J Invasive Cardiol. 2012 Sep;24(9):428-32.

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Net clinical benefit of prehospital glycoprotein IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score.

Hermanides RS, Ottervanger JP, ten Berg JM, Gosselink AT, van Houwelingen G, Dambrink JH, Stella PR, Hamm C, van ‘t Hof AW; On-TIME 2 Trial Investigators.  J Invasive Cardiol. 2012 Mar;24(3):84-9.

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Long-term reduction of mortality in the 4-year follow up of tirofiban therapy in elective percutaneous coronary interventions (TOPSTAR) trial.

Lengenfelder B, Stoerk S, Boes L, Strotmann J, Ertl G, Voelker W, Bonz AW. J Invasive Cardiol. 2011 Apr;23(4):128-32.

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