IIB/IIIA inhibitors of platelet glycoprotein receptors for treating patients with acute coronary syndrome and elevated ST segment
Purpose: To evaluate the efficacy and complications of Tirofiban in patients with acute coronary syndrome and ST- segment elevation in the rescue recutaneous coronary angioplasty after failed thrombolysis. Materials and Methods. The study included 112 patients who were randomly assigned to two groups: in Group I the rescue PCI with stenting was performed, in Group II the rescue PCI was added with Tirofiban. Results. While analyzing immediate outcomes (0-30 days), it has been shown that there were no significant differences between incidence and severity parameters in the two groups: incidence (Group I - 13.7%, Group II - 19.2%) and severity of bleeding (p> 0.05). In Tirofiban group there was a significant increase of left ventricle ejection fraction: 6 ± 3% vs 3 ± 5% in Group I (p = 0.005). Late events (31-180 days) were significantly less frequent in Group II (5.8% vs 21.6% in Group I, p <0.05). The multivariate analysis showed that cardiogenic shock (OR = 6.8, 95% CI: 1.8-26, p = 0.005) was an independent risk factor of marked cardiovascular complications and events within 6 months after PCI. Only Tirofiban during PCI significantly weakened pronounced cardiovascular complications and events within 6 months after PCI (OR = 0.15, 95% CI: 0.4-0.53, p = 0.003). Conclusions. Urgent PCI in combination with administration of IIb / IIIa inhibitor of platelet glycoprotein receptors (Tirofiban) can effectively and safely achieve optimal results in patients with acute coronary syndrome and ST-segment elevation after failed thrombolysis. Long-term prognosis in patients after rescue PCI may be improved if during the procedure patients receive IIb / IIIa inhibitors of platelet glycoprotein receptors, but at the same time this prognosis gets much worse in case of cardiogenic shock.