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Myocardial Staining (TMPG 1)  Post-Stent in AMI

Myocardial Staining (TMPG 1)  Post-Stent in AMI. p = 0.004. 28.6%. % TMPG 1. 13.5%. n = 118. n = 118. CM Gibson, J Thrombolysis & Thrombosis, 2002 in press. Intracoronary Devices and Embolic Potential. Topol, E. Circulation. 2000;101:570-580.

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Myocardial Staining (TMPG 1)  Post-Stent in AMI

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  1. Myocardial Staining (TMPG 1)  Post-Stent in AMI p = 0.004 28.6% % TMPG 1 13.5% n = 118 n = 118 CM Gibson, J Thrombolysis & Thrombosis, 2002 in press

  2. Intracoronary Devices and Embolic Potential Topol, E. Circulation. 2000;101:570-580.

  3. Intracoronary Serotonin Release After Stenting Stenting causes greater serotonin release than PTCA Stenting may cause greater arterial damage, greater plt. deposition, and greater plt. activation leading to vasoconstriction Leosco et al, AJC 1999;84:1317-1322

  4. Impact of IC Adenosine & GP 2b3a Inhibitor on TIMI Myocardial Perfusion Grade Post PTCA Post PTCA + Adenosine Distal LAD with TIMI 3 Grade Blush Distal LAD with no blush (DSA = 0.1 Gray) (DSA = 5.2 Gray) CM Gibson 2000

  5. Impact of IC Adenosine on Clinical & Electrocardiographic Outcomes in the Setting Primary PTCA Placebo Adenosine 4 mg in 2 ml via central lumen of PTCA balloon N=27 N=27 p < 0.02 p < 0.03 p < 0.04 % of Patients % Developing Q Waves % Death, MI, CHF, Recurrent Angina Marzilli et al, Circulation 2000; 101:2154-2159

  6. Hypothermia in MI Reduces Infarct Size No Cooling Cooling

  7. Non-culprit CTFCs Improve Following PCI of the Culprit Artery • Dilating the culprit stenosis speeds up flow in the uninvolved artery (non-culprit artery) in acute coronary syndromes 10.4 + 16.0 P < 0.0001 CTFC Improvement in Non-Culprit N = 134 N = 228 - 0.7 + 8.6 Gibson CM et al, Am J Cardiol 2000

  8. Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI Gregorini et al, Circulation 1999; 99: 482-490

  9. Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI Gregorini et al, Circulation 1999; 99: 482-490

  10. Downstream Targets • Large embolii: Filters • Small embolii (thrombii): Filters & GP 2b3a inhibitors • Vasoconstrictor release: GP 2b3a inhibitors • Spasm: Adenosine, Ca channel blockers, alpha blockers, avoid over sizing with PCI, high pressure inflations, serotonin inhibitors, endothelin inhibitors • Endothelial & Myocardial swelling: Ca channel blockers, hypothermia, DHEA, Na / H pump inhibitors, anti-inflammatory approaches

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