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Glycoprotein Inhibitors and Fibrinolysis in Myocardial Infarction—Reply

Deepak L. Bhatt, MD; Eric J. Topol, MD
JAMA. 2000;284(24):3124-3125. doi:10.1001/jama.284.24.3123.
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In Reply: Fibrinolysis has a proven role in the treatment of myocardial infarction (MI) with ST-segment elevation. Glycoprotein IIb/IIIa inhibition is established as an adjunct to primary percutaneous intervention (PCI) for acute MI. The Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO) III trial examined the use of abciximab in patients who had ongoing ischemia following fibrinolysis with full-dose reteplase or alteplase and subsequently underwent rescue PCI with abciximab.1 There was a trend towards a lower 30-day mortality in the 83 patients who received abciximab, although these patients did have more episodes of severe bleeding. An analysis of the patients in Strategies for Patency Enhancement in the Emergency Department (SPEED) who underwent PCI within 60 to 90 minutes of receiving abciximab and reduced-dose reteplase revealed a low rate of mortality, MI, or urgent revascularization at 30 days.2 Similarly, an analysis from the Integrilin and Reduced Dose of Thrombolytics in Acute Myocardial Infarction (INTRO-AMI) trial showed that early PCI after reduced-dose alteplase and eptifibatide also resulted in a relatively low rate of death or reinfarction.3 This concept of prompt chemical reperfusion followed by early PCI is now commonly referred to as "facilitated PCI."


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