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Abdallah G Rebeiz

Publications and source records attributed to Abdallah G Rebeiz.

12 recordsLinked to original sources
PubMed2005

Comparison of ST-segment resolution with combined fibrinolytic and glycoprotein IIb/IIIa inhibitor therapy versus fibrinolytic alone (data from four clinical trials).

We compared combination fibrinolytic plus glycoprotein IIb/IIIa inhibitor therapy with stand-alone fibrinolysis with respect to speed and stability of reperfusion in patients who had acute ST-segment elevation myocardial infarction; data were obtained from 654 patients in 4 trials (Integrilin to Manage Platelet Aggregation to Combat Thrombosis in Acute Myocardial Infarction, Platelet Aggregation Receptor Antagonist Dose Investigation and Reperfusion Gain in Myocardial Infarction, Integrilin and Tenecteplase in Acute Myocardial Infarction, and the Fifth Global Use of Strategies to Open Occluded Coronary Arteries) that compared thrombolytics plus lamifiban, eptifibatide, or abciximab with standard thrombolysis. We found significantly faster and more stable ST-segment recovery with combination therapy starting at 60 minutes (56.7% vs 48.0% with >/=50% ST-segment resolution, p = 0.03) and sustained over 180 minutes after drug administration; this transient benefit may suggest a time frame when more optimal percutaneous coronary intervention can be performed.

Abciximab↗
PubMed2005

Interventional cardiovascular pharmacotherapy: current issues.

In the last decade, a variety of novel anticoagulant and antiplatelet agents that improve outcomes in patients undergoing percutaneous coronary revascularization have emerged. During the next decade, continued refinements in catheter-based device technology should lead to further increases in the number of interventional procedures. The use of optimal antithrombotic strategies is pivotal in reducing adverse events among patients undergoing percutaneous coronary intervention (PCI). Our purpose is to review the current evidence regarding the efficacy of available adjunctive anticoagulant and antiplatelet agents in treating patients undergoing percutaneous coronary revascularization. It should be borne in mind that patients undergoing PCI in the midst of an acute coronary event require a different level of coagulation and platelet aggregation inhibition than low-risk patients undergoing elective PCI for stable angina pectoris. Similarly, generalizing antithrombotic regimen safety data to a wide spectrum of catheter-based therapeutic devices should be avoided. A level of anticoagulation that is safe and effective for angioplasty and stent placement may not be sufficient for devices with longer intracoronary dwell times such as brachytherapy catheters. In light of current evidence, activated clotting times should be targeted in the 200- to 250-second range during elective PCI and in the 250- to 300-second range when intervening on a higher-risk lesion, such as one with an angiographically visible thrombus or in patients presenting with an acute coronary syndrome (ACS).Low-dose enoxaparin sodium is an attractive antithrombin strategy in PCI because it is intrinsically adjusted for renal function, age, and concomitant glycoprotein (GP) IIb/IIIa antagonist use. Other low-molecular weight heparins have also been studied as adjunctive anticoagulants during cardiac catheterization. For example, in pilot studies, dalteparin sodium was shown to have a good safety profile when used alone or in combination with abciximab during PCI.A wealth of data supports the use of a GP IIb/IIIa antagonist in patients presenting with ACS, especially those with high-risk features such as elevated cardiac markers; the systematic use of GP IIb/IIIa inhibitors in this population is therefore encouraged. Overall, the use of GP IIb/IIIa inhibitors reduces the incidence of thrombotic complications following PCI, is associated with a mortality benefit, but has no impact on the risk of restenosis.

Angioplasty, Balloon, Coronary↗
PubMed2004

Optimal duration of eptifibatide infusion in percutaneous coronary intervention (an ESPRIT substudy).

Although randomized trials have clearly demonstrated the clinical efficacy with regimens of platelet glycoprotein IIb/IIIa antagonists that result in >80% inhibition of baseline platelet aggregation in percutaneous coronary intervention (PCI), there are no data available concerning the optimal duration of infusion of these agents. In an era when the length of hospitalization has a major impact on health care costs, the determination of the optimal duration of the infusion of these drugs after PCI is of great relevance. The investigators therefore sought to determine the optimal length of the infusion of eptifibatide after PCI by analyzing the outcomes of patients enrolled in the Enhanced Suppression of the Platelet IIb/IIIa Receptor With Integrilin Therapy trial who were randomized to treatment with eptifibatide.

Angioplasty, Balloon, Coronary↗
PubMed2004

Integrating antithrombin and antiplatelet therapies with early invasive management for non-ST-segment elevation acute coronary syndromes.

Non-ST-segment elevation acute coronary syndromes are a dramatic manifestation of coronary artery disease. Multiple clinical trials have shown that early cardiac catheterization improves clinical outcomes in patients with non-ST-segment elevation acute coronary syndromes. Many antithrombotic agents effectively manage unstable coronary syndromes and serve as adjuncts to percutaneous coronary intervention. Yet, the growing number of pharmacologic agents makes early management of non-ST-segment elevation acute coronary syndromes increasingly complex. We review the current evidence regarding the optimal integration of early antithrombotic and antiplatelet therapies with early coronary angiography and subsequent revascularization.

Algorithms↗
PubMed2004

Left main coronary artery-to-pulmonary artery fistula with severe aneurysmal dilatation.

Coronary artery fistulas (CAF) are rare abnormalities that can be symptomatic or asymptomatic. Most drain into the right ventricle or pulmonary artery, though a variety of other drainage sites have been reported. We report the results of the surgical closure of a symptomatic left coronary-to-pulmonary artery fistula associated with a giant 10-cm aneurysm and discuss the management of coronary artery fistulas.

Arterio-Arterial Fistula↗
PubMed2004

Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention and medical therapy for multivessel disease with and without left ventricular dysfunction.

Multiple randomized trials support the treatment of patients with multivessel coronary artery disease (CAD) and relatively normal left ventricular (LV) ejection fraction (EF) by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). However, there has been a paucity of trials in the recent literature that have compared the outcomes of patients with multivessel CAD and low EF who undergo PCI or CABG. This review examines some of the clinical trials and series in this subgroup of patients and also compares the outcome of patients undergoing either procedure in the absence and presence of LV dysfunction. These trials and series support the notion that PCI can be successfully performed in patients with low EF with relatively low mortality, but that CABG is associated with greater freedom from repeat revascularization and from angina or congestive heart failure symptoms. In addition, most of the data published thus far indicate a long-term survival advantage among patients with ventricular dysfunction who have undergone CABG. Further studies, including randomized trials incorporating the evolving techniques of CABG and the recent advances in PCI, will be needed to assess the proper role and outcome of these two interventions.

Angioplasty, Balloon, Coronary↗
PubMed2003

Contrast nephropathy : an evidence-based approach to prevention.

Contrast-induced nephropathy occurs in 2-10% of patients exposed to intravascular radiographic contrast agents and results in significant morbidity and mortality. Although the exact mechanism of this disorder has not been fully elucidated, contrast nephropathy is probably due to a combination of decreased renal medullary blood flow, resulting in medullary ischemia, and direct toxicity to renal tubules. Contrast nephropathy is most commonly defined as either a >25% increase or a >0.5 mg/dL rise in serum creatinine level within 48 hours of contrast medium exposure. Baseline characteristics associated with an increased risk for development of contrast nephropathy include the presence of baseline renal dysfunction, diabetes mellitus, congestive heart failure, volume depletion, and concomitant administration of nephrotoxic drugs. Many strategies have been investigated in an effort to prevent the occurrence of renal dysfunction following contrast media exposure. Intravenous hydration has been shown to significantly decrease the incidence of nephropathy in high-risk patients. However, trials of several prophylactic pharmacologic interventions have been mostly disappointing, including the administration of calcium channel antagonists, diuretics, dopamine, endothelin receptor antagonists and fenoldopam. The use of N-acetylcysteine has been shown in some trials to decrease the incidence of contrast nephropathy in patients with a baseline renal dysfunction, and should currently be strongly considered in this high-risk patient subgroup in addition to hydration. Our purpose is to review the contemporary literature regarding contrast-induced renal dysfunction and present an evidence-based approach for prevention of this complication.

Acute Kidney Injury↗