Safety and Efficacy of the Use of Glycoprotein IIb/IIIa Inhibitors in Invasive Treatment of Patients With ST-Elevation Acute Coronary Syndrome

The purpose of the study was to estimate the safety and the efficacy of the use of tirofiban, its influence on the function of the left ventricle of the heart and the clinical outcome of the patients with ST-elevation acute coronary syndrome (ACS) during the rescue coronary angioplasty after the unsuccessful thrombolysis. The study included 112 patients who were randomized into two groups: in group I rescue percutaneous coronary intervention (PCI) with stenting was carried out, the patients in group 2 were administered tirofiban and rescue PCI was conducted. Analysis of the immediate events (0-30 days) showed that in the frequency (group I - 13.7%, group 11 - 19.2%) and intensity of bleeding there were no distinct differences between groups (p>0.05). In the tirofiban group the distinct growth in the ejection fraction LV (6 +/- 3% versus 3 +/- 5% in group 1, p=0.005) was recorded. Late events (31-180 days) occurred significantly more rarely in group 11 (5.8% versus 21.6% in group 1, p<0.05). Multivariate analysis showed that the development of cardiogenic shock (OR=6.8, 95%Cl: 1.8-26, p=0.005) was an independent risk factor of prominent cardiovascular complications and events during 6 months after PCI. Thus only the use of tirofiban during PCI had a significant effect of the decrease of significant cardiovascular complications and events during 6 months after PCI (OR=0.15, 95%Cl: 0.04-0.53, p=0.003). Conclusion: the performance of rescue PCI in combination with glycoprotein IIb/IIIa inhibitors allows to reach optimal results of the treatment of patients with ST-elevation ACS after failed thrombolysis. The remote prognosis of patients after rescue PCI improves if during the intervention a patient receives IIb/IIIa inhibitors of glycoprotein receptors but at the same time considerably worsens in case of cardiogenic shock development.