Platelet Glycoprotein IIb/IIIa Inhibition with Coronary Stenting for Acute Myocardial Infarction

Montalescot, Gilles; Barragan, Paul; Wittenberg, Olivier; Ecollan, Patrick; Elhadad, Simon; Villain, P; Boulenc, Jean-Marc; Morice, Marie‐Claude; Maillard, Luc; Pansiéri, Michel; Choussat, Rémi; Pinton, Philippe

doi:10.1056/nejm200106213442503

Cited by 1,049 publications

(371 citation statements)

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“…43 Early administration of these agents, especially during the prehospital management phase, has been shown to improve coronary patency, with favourable trends for clinical outcome. 44 Importantly, a recent analysis obtained in a more homogeneous study population representative of modern primary PCI practice (n=1,101) [45][46][47] providing for the first time long-term follow-up to three years, confirmed a reduction in hard clinical outcomes with the use of GP IIb/IIIa receptor antagonists. This risk reduction translates into 50 major events (death or reinfarction) prevented for every 1,000 patients treated: this benefit increases five-fold in diabetics, with 250 deaths or MIs prevented for every 1,000 diabetic patients treated.…”

Section: Why Do Reperfusion Therapies Fail In Diabetics With Stemi?mentioning

confidence: 90%

The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes

Collet

Montalescot

2005

Diabetes and Vascular Disease Research

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Diabetes mellitus (DM) remains an important predictor for mortality in patients with ST-segment Elevation Myocardial Infarction (STEMI) although the use of reperfusion therapy has resulted in a considerable improvement of survival. Of importance, newly diagnosed diabetic patients and those with fasting glycaemia in the diabetes range have even worse outcomes compared to patients with known diabetes. Overall, 50% of all patients presenting with STEMI have abnormal glucose metabolism of which fewer than 50% are known diabetics. Obviously, the efficacy of reperfusion therapy in reopening the occluded artery is similar in STEMI patients with or without impaired fasting glycaemia, while the pre-existing decreased myocardial perfusion in STEMI patients with impaired fasting glycaemia persists after successful epicardial revascularisation.There is no doubt that improving microvascular perfusion within the ischaemic myocardium remains the ultimate goal of managing STEMI patients with impaired glucose metabolism. Identification of defective myocardial perfusion together with an aggressive antithrombotic regimen, reduction of the inflammatory response of the ischaemic myocardium and improvement of glycaemia control represent promising therapeutic approaches that deserve additional specific clinical investigations. This review examines all these important issues. 2005;2:136-43 Diabetes Vasc Dis Res

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Section: Why Do Reperfusion Therapies Fail In Diabetics With Stemi?mentioning

confidence: 90%

The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes

Collet

Montalescot

2005

Diabetes and Vascular Disease Research

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“…On these bases, we suggest that, in these patients, the therapeutic strategies currently considered efficient in reducing mortality in acute myocardial infarction should be 6 1 9 used preferentially and early, being initiated in the emergency department 39,40 .…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

Dg¹,

Pj²,

Jn³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceará state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment

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“…Figure 6 compares the results of the ISODATA technique with those of the ANN. As shown in this figure the lesion areas in the ISODATA maps are clustered to different signatures (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Signatures range between one (corresponding to normal tissue) to twelve (corresponding to CSF or cavitated tissue).…”

Section: Resultsmentioning

confidence: 90%

“…Many studies, by correlating with follow-up imaging or neurological status, have shown the potential for diffusion weighted imaging (DWI), perfusion weighted imaging (PWI), and/or T 2 -weighted (T2WI) magnetic resonance imaging (MRI) used together for staging stroke outcome [3,7,8]. Most of these analyses were performed using as an outcome metric the volume of a region-of-interest (ROI) defined by the difference between an acute data set and the outcome image [9,10,11]. For instance, it has been shown that an unsupervised clustering technique such as ISODATA (Iterative Self-Organizing Data Analysis) can utilize combined MRI data sets from the acute phase [2,12] and the subacute phase [5] post-stroke to predict final infarct volume and thus produce a time-independent surrogate MRI outcome predictor [13,14,15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Predicting final extent of ischemic infarction using an artificial neural network analysis of multiparametric MRI in patients with stroke

Bagher‐Ebadian

Jafari-Khouzani

Mitsias

et al. 2009

2009 International Joint Conference on Neural Networks

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In hemispheric ischemic stroke, the final size of the ischemic lesion is the most important correlate of clinical functional outcome. Using a set of acute-phase MR images (Diffusion-weighted -DWI, T 1 -weighted -T1WI, T 2 -weighted-T2WI, and proton density weighted -PDWI) for inputs, and the chronic T2WI at 3 months as an outcome measure, an Artificial Neural Network (ANN) was trained to predict the 3-month outcome in the form of a voxel-by-voxel forecast of the chronic T2WI.The ANN was trained and tested using 12 subjects (with 83 slices and 140218 voxels) using a leave-one-out cross-validation method with calculation of the Area Under the Receiver Operator Characteristic Curve (AUROC) for training, testing and optimization of the ANN. After training and optimization, the ANN produced maps of predicted outcome that were well correlated (r = 0.80, p,0.0001) with the T2WI at 3 months for all 12 patients. This result implies that the trained ANN can provide an estimate of 3-month ischemic lesion on T2WI in a stable and accurate manner (AUROC = 0.89).

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Platelet Glycoprotein IIb/IIIa Inhibition with Coronary Stenting for Acute Myocardial Infarction

Abstract: As compared with placebo, early administration of abciximab in patients with acute myocardial infarction improves coronary patency before stenting, the success rate of the stenting procedure, the rate of coronary patency at six months, left ventricular function, and clinical outcomes.

Cited by 1,049 publications

References 32 publications

The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes

The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

Predicting final extent of ischemic infarction using an artificial neural network analysis of multiparametric MRI in patients with stroke

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