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(Circulation. 1998;98:1249-1250.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Platelet Glycoprotein IIb/IIIa Receptor Blockade in Acute Myocardial Infarction Associated With Thrombotic Occlusion of the Left Main Coronary Artery

Eldad Rechavia, MD; ; Mordechai Wurzel, MD

From the Cardiac Catheterization Unit, Rabin Medical Center, Beilinson Campus, Tel Aviv University Sackler School of Medicine, Israel.

Correspondence to Dr Eldad Rechavia, Cardiac Catheterization Unit, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.

Several reports have recently opened a new therapeutic window for the use of platelet glycoprotein (GP) IIb/IIIa receptor blockade as an adjunct to thrombolytic therapy in acute myocardial infarction.^{1 2} Because of the different protocols and the different agents that were used, as well as the relatively small number of patients included in these studies, one cannot draw any definitive conclusions about the efficacy of platelet GP IIb/IIIa receptor blockers as an adjunct to thrombolysis. Nevertheless, one could also make a case for the use of GP IIb/IIIa receptor blockers even as a monotherapy for acute myocardial infarction, as in the following case.

A 36-year-old, previously healthy male who was a heavy smoker was admitted with intermittent chest pain of 4 hours' duration and ECG findings compatible with an acute anterior wall myocardial infarction (Figure 1). The patient was treated with aspirin (325 mg) and underwent emergency coronary angiography. This demonstrated multiple filling defects consistent with thrombotic occlusions involving the left main (Figures 2 and 3), the proximal left anterior descending, and the right (Figure 4) coronary arteries. At this stage, intravenous heparin (5000 U) was administered, achieving an activated clotting time of 265 seconds. Standard-dose, weight-adjusted abciximab was administered as a bolus, and continuous infusion was subsequently started for 12 hours, together with heparin, maintaining an activated partial thromboplastin time between 60 and 80 seconds. A few minutes after abciximab bolus injection, chest pain was relieved and gradual resolution of ST-segment elevation was apparent. Over the following . . . [Full Text of this Article]

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