الفهرس 
ACUTE MYOCARDIAL
Management Of STEMIOnly 14 pages are availabe for public view
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Abstract
7. This study was done to examine the angiographic and clinical outcomes in patients with ST-segment elevation AMI (STEMI) undergoing primary PCI using different dosing regimens of tirofiban therapy, especially the double upstream intravenous bolus dose and the additional downstream intracoronary bolus dose regimens in comparison to the conventional single upstream intravenous bolus dose.
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9. The study was conducted on 60 patients who came to the emergency room at Ain Shams University and Ain Shams University Specialized Hospitals complaining of acute chest pain and were diagnosed as having acute anterior ST segment elevation myocardial infarction. All patients were treated by primary percutaneous coronary intervention.
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11. The patients were divided into three groups according to the bolus dose of Tirofiban which was given randomly, each group included 20 patients: Group I received the conventional single intravenous bolus dose of Tirofiban upstream in the CCU prior to primary PCI (0.4 μg/kg/min for 30 min i.e. 12 μg/kg), Group II received a high (double) intravenous bolus dose of Tirofiban upstream in the CCU prior to primary PCI (25 μg/kg) and Group III received 12 μg/kg bolus dose Tirofiban intracoronary downstream in the catheterization laboratory in addition to the upstream intravenous bolus dose.
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13. All patients were subjected to Thorough history taking and complete physical examination, 12 leads surface ECG, laboratory investigations including serial cardiac enzymes, Patient preparation by antiplatelets and heparin, Tirofiban (Ŗ/Aggrastat) bolus dose according to the group, emergency coronary angiography and coronary angioplasty of the infarct related artery (1ry PCI) in which TIMI flow and myocardial blush grade (MBG) were evaluated, transthoracic Echocardiography, and clinical follow during in-hospital stay.
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15. Most of the patients included in the study were presented with Killip class I, and it was statistically non- significant in-between groups.
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17. The mean door to needle time and door to balloon time was statistically non-significant in-between groups.
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19. The mean peak cardiac enzymes was measured. Early peaking of the total CK was observed in nearly all of the patients in the sample taken after reperfusion signifying successful reperfusion, and although, the mean and SD of peak cardiac enzymes was less in the high bolus dose group but it was statistically non- significant among the three groups.
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21. Coronary angiographic asessment revealed that most of patients in the studied groups had totally occluded LAD with TIMI 0 flow prior to intervention. PTCA and stenting was done for most of patients except one patient in group II who was found to have recanalized LAD. Post PCI TIMI flow assessment revealed achievement of TIMI III flow in 90% of group II patients and it in 70% of group I and group III patients, but this was statistically non- significant.
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23. The no reflow phenomenon was significantly lower in incidence in the group II in comparison to group I, but it was statistically non-significant between group II and group III and between group I and group III.
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25. The myocardial perfusion assessment revealed that the high bolus dose group has better myocardial perfusion with a significantly higher blush grade (MBG III in 70% of group II, 30% of group III patients and 20% of group I patients) than the other two groups.
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27. During hospital stay, all patients were assessed by Trans-thoracic echocardiography. The LV systolic function was better in the high bolus dose group (mean and SD of EF was 48.95±8.69) with a highly significant difference in comparison to the other two groups (41.65±7.82 in group I and 41.20±8.21 in group III), while there was no statistical significance between the conventional bolus dose group and the intracoronary bolus group. The incidence of mitral regurgitation was significantly lower in the high bolus dose group in comparison to the other two groups (5% in group II, 30% in group III and 40% in group I).
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29. In the present work, the incidence of recurrent ischemia was significantly lower in the high bolus dose group (5%) in comparison to the intracoronary group (30%), and although the incidence of MACE was fewer than the standard bolus dose regimen, but this was statistically non- significant. There was no statistical significance between the standard bolus dose and the intracoronary group. Death and target vessel revascularization were statistically non- significant in-between groups. In the present study, the different dosing regimens of tirofiban were safe and the bleeding complications were minimal and did not differ between the study groups.