Comparison of different strategies for acute ST-segment elevation myocardial infarction with high thrombus burden in clinical practice: Symptom-free outcome at one year

Heart Lung. 2015 Nov-Dec;44(6):487-93. doi: 10.1016/j.hrtlng.2015.08.003.

Abstract

Objective: The aim of this study was to evaluate the clinical effects of different strategies for preventing coronary microvascular obstruction in ST elevation myocardial infarction (STEMI) patients with a high thrombus-burden plaque.

Methods: Between January, 2007 and December, 2012, 354 patients suffering from STEMI with high thrombus-burden were enrolled and divided into three groups as the first group received a GP IIb/IIIa inhibitor, and the second group received a distal protective device, and the third group was treated with primary PCI alone.

Results: A high percentage of patients in the GP IIb/IIIa inhibitor (96.8% and 90.5%), distal protective device (99.3% and 87.6%) had better thirty-day and one-year symptom-free outcomes when compared with PCI only group (91.6% and 65.6%) (P = 0.008 and P < 0.001; respectively).

Conclusions: Treatment with intracoronary GP IIb/IIIa inhibitor injection or distal protection device to prevent coronary microvascular obstruction was demonstrated to increase the occurrences of thirty-day and one-year symptom-free outcomes; thus, these treatments can help decrease post-MI medical care costs.

Keywords: Distal protection device; GP IIb/IIIa receptor inhibitor; High thrombus-burden plaque; Primary percutaneous coronary intervention; ST elevation myocardial infarction; Symptom-free outcomes.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Thrombosis / etiology
  • Coronary Thrombosis / prevention & control*
  • Dose-Response Relationship, Drug
  • Electrocardiography*
  • Female
  • Humans
  • Injections, Intra-Arterial
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / therapy*
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
  • Tirofiban
  • Tyrosine / administration & dosage
  • Tyrosine / analogs & derivatives*

Substances

  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Tyrosine
  • Tirofiban