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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