Triple antiplatelet therapy in percutaneous coronary intervention in st-elevation myocardial infarction

The aim of the study was to analyze the results of primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) treated with double or triple antiplatelet therapy, referring to the combination of aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa blocker. Methods and results: 794 STEMI patients were treated with primary PCI in the Myticshi City hospital from January 2008 to May 2012. The mean age was 58 ± 5,7 years. All patients received aspirin 300 mg, clopidogrel 600mg and unfractionated heparin 10000 IU. If angiogram revealed severe signs of coronary thrombosis, GP IIb/IIIa blocker was initiated. GP IIb/IIIa blockers eptifibatide and 11^^111 in standard doses were used in 64 and 46 patients respectively. In 180 patients was performed rescue PCI after failed thrombolytic therapy with streptokinase. Immediate clinical effectiveness of primary PCI was 98,7%. TIMI III blood flow was not achieved in 11 patients due to the «no-reflow» phenomenon. The use of GP IIb/IIIa blockers lead to the restoration of optimal blood flow in all 28 patients with «no - reflow» phenomenon. 12 patients (1,5%) died in the early hospital period (3 days). The causes of death were hemorrhagic stroke in 0,3% (patients treated with both thrombolytic and GP IIb/IIIa blocker) and left ventricular free wall rupture (1,2%). Acute stent thrombosis occurred in 4 patients (0,5%). The repeated PCI was safely performed and eptifibatide therapy was initiated in these patients. Conclusions: Primary PCI with adjuvant triple antiplatelet therapy including GP IIb/IIIa blockers is highly effective. The use of GP IIb/IIIa blockers seems to decrease the risk of «no-reflow» phenomenon.