Randomized early versus late abciximab in acute myocardial infarction treated with primary coronary intervention (RELAx-AMI Trial).

Objectives: This prospective randomized trial evaluates the impact of early abciximab administration on angiographic and left ventricular function parameters.

Background: Glycoprotein IIb/IIIa inhibitors improve myocardial reperfusion in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), but optimal timing of administration remains unclear.

Methods: Two-hundred ten consecutive patients with first AMI undergoing primary PCI were randomized to abciximab administration either in the emergency room (early group: 105 patients) or in the catheterization laboratory, after coronary angiography (late group: 105 patients).

[Sirolimus-eluting stent for in-stent restenosis treatment: single center results in an unselected study population].

Background: Sirolimus-eluting stents have already proved to be efficient in the prevention of restenosis in de novo lesions and have been already proposed as a potential treatment of in-stent restenosis. In the present study, we evaluated the effectiveness of sirolimus-eluting stent implantation in unselected patients with in-stent restenosis.

Methods: Fifty consecutive patients (59 lesions) were treated with sirolimus-eluting stents for instent restenosis.

Effects of tirofiban plus clopidogrel versus clopidogrel plus provisional abciximab on biomarkers of myocardial necrosis in patients with non-ST-elevation acute coronary syndromes treated with early aggressive approach. Results of the CLOpidogrel, upstream TIrofiban, in cath Lab Downstream Abciximab (CLOTILDA) study.

Background: In non-ST-elevation acute coronary syndromes (NSTE-ACS), a strong correlation between adverse clinical events and peak values of myocardial necrosis markers has been found. In this study, we evaluated whether the adjunctive treatment with upstream tirofiban reduces the peak levels of cardiac troponin I and creatine kinase-MB (CK-MB) fraction in patients with NSTE-ACS undergoing early invasive strategy and pretreated with aspirin, heparin, and clopidogrel.

Methods: A total of 300 patients were randomized to receive tirofiban (group 1) or not (group 2).

Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours.

In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI.

[Non-ST-elevation acute coronary syndromes: the problem of the elderly patient].

The elderly population represents a relevant proportion of patients with non-ST-elevation acute coronary syndromes and are at increased risk because of the greater extent of coronary artery disease, a reduction in left ventricular ejection fraction, and associated comorbidities. Results from registries and post-hoc analysis of randomized clinical trials have shown that an early invasive strategy with myocardial revascularization when indicated offers a greater clinical benefit in the elderly that in younger patients despite an increased procedural risk in elderly patients.

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty.

Background: Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion.

Hypothesis: We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).

Methods: In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI.

Therapeutic strategies, immediate and mid-term outcomes in non-ST-segment elevation acute coronary syndromes with respect to age: a single-center registry of 488 consecutive patients.

Background: Elderly patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE-ACS in the elderly has not been fully investigated.

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction.

Purpose: Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI.

Increase of myocardial salvage and left ventricular function recovery with intracoronary abciximab downstream of the coronary occlusion in patients with acute myocardial infarction treated with primary coronary intervention.

In this prospective randomized trial on patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI), we hypothesized that abciximab administered intracoronarily, downstream of the coronary occlusion, leads to a greater degree of myocardial salvage and better left ventricular function recovery compared with the usual abciximab administration. Forty-five consecutive patients with first AMI and infarct-related artery TIMI flow 0-1 undergoing primary PCI were enrolled. Twenty-two patients were randomly assigned to the intracoronary treatment and 23 to the usual treatment.

Gated SPECT evaluation of the relationship between admission troponin I, myocardial salvage, and functional recovery in acute myocardial infarction treated by abciximab and early primary angioplasty.

Unlabelled: Using gated SPECT, we evaluated the relationship between admission troponin I, risk area, and myocardial salvage in patients with a first myocardial infarction treated with abciximab and primary percutaneous coronary intervention within 6 h.

Methods: In 43 patients, (99m)Tc-sestamibi was injected before primary percutaneous coronary intervention. Gated SPECT was acquired immediately thereafter and was repeated 7 and 30 d later.