Coronary stenting and platelet glycoprotein IIb/IIIa receptor blockade in acute myocardial infarction

Abstract

Background Myocardial reperfusion in patients with acute myocardial infarction may be successfully achieved with primary angioplasty. However, angioplasty, as a primary reperfusion strategy, has limitations such as early recurrent ischemia and late restenosis and reocclusion. To improve the short- and long-term results of primary angioplasty, the use of adjunct strategies has been proposed. Methods We reviewed published studies on the effectiveness of primary angioplasty, stenting, and platelet glycoprotein IIb/IIIa receptor blockade and identified the advantages and disadvantages of these interventions in patients with acute myocardial infarction. Results Recent findings suggest that patients may benefit from stenting of the infarct artery and from the use of more potent antiplatelet agents such as platelet glycoprotein IIb/IIIa receptor inhibitors. In randomized trials that compared primary angioplasty versus primary stenting, stent implantation was associated with a lower rate of death, reinfarction, and especially target vessel revascularization. Platelet glycoprotein IIb/IIIa receptor inhibitors prevented acute ischemic complications after primary angioplasty and primary stenting. In addition to maintaining large vessel patency, these drugs may protect the microvasculature after primary stenting, allowing better functional recovery of the risk area. Conclusions Coronary artery stenting in acute myocardial infarction reduces the rate of restenosis and the incidence of problems related to recurrent ischemia. Platelet glycoprotein IIb/IIIa receptor inhibitors may come to play a key role in association with mechanical reperfusion. However, the cost-effectiveness and long-term clinical outcome of this combined pharmacologic/mechanical intervention require further study before this strategy can be recommended for routine use. (Am Heart J 2001;141:S26-35.)