PubMed2002
AIM: To evaluate the risks and the significance of the use of an anti-GPIIb/IIIa, in this case Eptifibatide, during angioplasty following presumed failure of thrombolysis in the acute phase of myocardial infarction. METHOD: Patients thrombolyzed following MI < 6 hours. Presumed failure of reperfusion with full dose thrombolysis. Analysis evaluated the success of angioplasty associated with anti-GPIIb/IIIa treatment and the hospital phase outcome. RESULTS: 41 consecutive patients, 32 male (78%) and 9 female (22%), were included. Infarction concerned the anterior region in 22 cases (54%) and inferior in 19 cases (46%). Fibrinolysis was performed using Alteplase in 28 patients (68%) and Reteplase in 13 patients (32%). Radial access was performed in 32 cases (78%). All of the patients received Eptifibatide with a bolus then infusion from their admission to the haemodynamic suite, on average 1 h 30 after the start of thrombolytic treatment. A total of 49 stents were implanted in 41 patients. A flux of TIMI 3 was obtained in 37 patients (90.2%). TIMI 2 in 2 patients (4.9%) and no reflow in 2 patients (4.9%). Four counter-pulsions by intra-aortic balloon were necessary (9.8%) for cardiogenic shock. No decrease in TIMI flux was observed after the angioplasty procedure. The main complications were a death from cardiogenic shock in one patients (2.4%), a non-fatal digestive tract haemorrhage in 2 cases (4.9%) and a single femoral haematoma requiring transfusion. CONCLUSION: The initial results were encouraging: high success rates, rare vascular complications, a probable consequence of the radial approach. The association of an anti-GPIIb/IIIa, Eptifibatide, therefore appears achievable during angioplasty with the positioning of a coronary endoprosthesis following the presumed failure of full dose thrombolysis.