tailieunhanh - ABC OF INTERVENTIONAL CARDIOLOGY – PART 4

Điều này khiến một số kiểm tra việc sử dụng các glycoprotein IIb / IIIa adjunctive chất ức chế như một giải pháp. Đặt stent và glycoprotein IIb / IIIa chất ức chế nghiên cứu đầu tiên (Cadillac) để kiểm tra những lợi ích tiềm năng của glycoprotein IIb / IIIa chất ức chế kết hợp với đặt stent cho thấy rằng abciximab đáng kể làm giảm thiếu máu cục bộ tái phát sớm và reocclusion do hình thành huyết khối. | Acute coronary syndrome ST segment elevation myocardial infarction However one study Stent-PAMI showed that stenting was associated with a small but significant decrease in normal coronary flow and a trend towards increased six and 12 month mortality. This led some to examine the use of adjunctive glycoprotein IIb IIIa inhibitors as a solution. Stenting and glycoprotein IIb IIIa inhibitors The first study CADILLAC to examine the potential benefits of glycoprotein IIb IIIa inhibitors combined with stenting showed that abciximab significantly reduced early recurrent ischaemia and reocclusion due to thrombus formation. There was no additional effect on restenosis or late outcomes compared with stenting alone. The slightly reduced rate of normal coronary flow that had been seen in other studies was again confirmed but did not translate into a significant effect on mortality. Another study ADMIRAL examined the potential benefit of abciximab when given before rather than during primary stenting. Both at 30 days and six months follow up abciximab significantly reduced the composite rate of reinfarction the need for further revascularisation and mortality. In addition abciximab significantly improved coronary flow rates immediately after stenting which persisted up to six months with a significant improvement in residual left ventricular function. Future of primary angioplasty Primary stenting is not only safe but by reducing recurrent ischaemic events also confers advantages over balloon angioplasty alone. Abciximab treatment seems to further improve flow characteristics prevents distal thrombo-embolisation and reduces the need for repeat angioplasty. A strategy of primary stenting in association with abciximab seems to be the current gold standard of care for patients with acute myocardial infarction. Future studies will examine the potential benefit of other glycoprotein IIb IIIa inhibitors. The question of whether on-site surgical cover is still essential for infarct .