Comparison between The Efficacy of Intracoronary Nitroglycerin versus Nitroglycerin Plus Glycoprotein Inhibitors for Treatment of Patients with Thrombolysis in Myocardial Infarction Flow Less Than Three during Primary Percutaneous Coronary Intervention | ||
| The Egyptian Journal of Hospital Medicine | ||
| Article 20, Volume 76, Issue 5, July 2019, Pages 4169-4175 PDF (422.02 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejhm.2019.43084 | ||
| Authors | ||
| Ahmed Mohamed Kamal Motaweh1; Mohamed Ahmed Mosaad Zaki1; Mahmoud Abd El-Naser Ahmed Hussieny* 2 | ||
| 1Department of Cardiology, Faculty of Medicine, Al-Azher University | ||
| 2Department of Cardiology, Al- Agoza Hospital | ||
| Abstract | ||
| Background: Primary percutaneous coronary intervention (PPCI) is currently the cornerstone of management in patients with ST-segment elevation myocardial infarction (STEMI). Aim of the work: comparison between the efficacies of intracoronary nitroglycerin (NTG) versus nitroglycerin plus glycoprotein inhibitors (GP) IIb/IIIa for treatment of patients with thrombolysis in myocardial infarction flow less than three during primary percutaneous coronary intervention. Patients and methods: we prospectively enrolled 30 patients with STEMI undergoing PPCI randomized to receive IC NTG only (n = 15) versus NTG plus GP IIb/IIIa inhibitors (n = 15) during PPCI. The primary outcome was the incidence of angiographic MVO as defined by thrombolysis in myocardial infarction flow less than 3 or thrombolysis in myocardial infarction flow 3 with myocardial blush grade less than 2. Results: NTG plus GP IIb/IIIa inhibitors were associated with better primary outcome compared to NTG only TIMI 3 & MBG > = 2 (40%vs 73.3%, respectively; P = 0.036). There was a trend towards improved left ventricular ejection fraction with NTG plus GP IIb/IIIa inhibitors (44.33 ± 9.76 vs 52.87 ± 11.23, respectively; P = 0.035). In addition, NTG plus GP IIb/IIIa inhibitors was associated with lower incidence of 30-day major adverse cardiovascular events (26.7 vs. 66.7% respectively; P = 0.028). Conclusion: In PPCI, NTG plus GP IIb/IIIa inhibitors resulted in significant improvements in no-reflow and MVO with a better safety profile compared to NTG only. Larger trials should be conducted to confirm these results. | ||
| Keywords | ||
| Acute myocardial infarction; Microvascular obstruction; Primary percutaneous coronary intervention; No reflow; Nitroglycerin; Platelets glycoprotein IIb/IIIa inhibitors | ||
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