Percutaneous coronary intervention or pci cardiac with stenting has revolutionized the care for patients with acute myocardial infarctions. Intracoronary stent placement in pci cardiac reduces the long-termrecurrence of stenosis.
In addition, the combination of stenting with administration of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor agents, which prohibit the binding of fibrinogen and proteins to platelets, has reduced the frequency of ischemic complications following pci cardiac.
GP IIb/IIIa therapy is indicated in patients undergoing coronary angioplasty, inparticular those patients with unstable angina or with other clinical characteristics of high risk.
Contraindications to GP IIb/IIIa inhibitors in pci cardiac include active bleeding, a bleeding diathesis in the past 30 days, intracranial tumors, intracranial hemorrhage, arteriovenous malformation, recent stroke, major surgery or traumain the preceding month, thrombocytopenia, severe hypertension, and aortic dissection.
The agents in this class include eptifibatide, tirofiban, and abciximab. Eptifibatide and tirofiban are preferred in patients with unstable angina and non-ST-elevation myocardial infarction (NSTEMI) managed medically, while abciximab is preferred in those undergoing pci cardiac.
The dose of abciximab as an adjunct in PCI is 0.125 mcg/kg/minute and when used for unstable angina the dose is 10 mcg/minute for 18 to 24 hours.
Tirofiban is dosed at 0.1 mcg/kg/minute and should be continued for 12 to 24 hours after PCI. Eptifibatide is dosed at 2 mcg/kg/minute after a 180-mcg/kg bolus for acute coronary syndromes.
The side effects of these medications include intracranial hemorrhage, gastrointestinal bleeding, thrombocytopenia, hematuria, retroperitoneal bleeding, and other severe bleeding diatheses.
It is important to note that stent technology has also improved over the past few years. The initial technology of stents has now been replaced by stents with better clinical outcomes.
The various types of stents include bare metal, self-expandable, balloon expandable, covered, small vessel, and drug eluting.
Current practice uses mostly drug-eluting stents in pci cardiac, which are coated with an antistenotic drug that is released over 14 to 30 days after implantation.
The two that are approved by the Food and Drug Administration are sirolimus- and paclitaxel-coated stents. Drug-eluting stents should be used preferentially in lesions involving the left-anterior descending artery and for left main disease.