Dj. Kereiakes et al., Therapeutic adjuncts for immediate transfer to the catheterization laboratory in patients with acute coronary syndromes, AM J CARD, 86(12B), 2000, pp. 10M-17M
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Early coronary intervention in patients with non-ST-segment elevation myoca
rdial infarction (MI) and unstable angina may be made safer and more effica
cious with concomitant therapies, including glycoprotein IIb/IIIa inhibitor
s and low-molecular-weight heparins. Stent placement has been shown to impr
ove procedural success and reduce major in-hospital complications when comp
ared with balloon angioplasty alone in patients with unstable angina. Howev
er, unstable angina remains a major hazard for adverse coronary events in l
ong-term follow-up after elective stent placement. The currently available
glycoprotein IIb/IIIa inhibitors-eptifibatide, tirofiban, and abciximab-hav
e each been shown to reduce ischemic events before percutaneous coronary in
tervention when administered to patients presenting with non-ST-segment ele
vation acute coronary syndromes in large clinical trials. The adjunctive ro
le of low-molecular-weight heparins in this scenario has been largely unexp
lored. Enoxaparin, when given before angiography or percutaneous coronary i
ntervention, has been shown to be superior to unfractionated heparin in pre
venting major coronary events. In this review, an algorithm for treatment o
f non-ST-segment elevation acute coronary syndromes is presented and the cu
rrent role of these newer adjunctive pharmacotherapies is explored. In the
future, combinations of these agents may prove to be most beneficial in pat
ients undergoing early percutaneous coronary intervention. (C) 2000 by Exce
rpta Medica, Inc.