Abdulmecit AFŞİN, Jülide YAĞMUR, Mehmet CANSEL

Abdulmecit Afşin, Jülide Yağmur, MehmetCansel

Akut ST elevasyonlu miyokard enfarktüsü kardiyak nedenli mortalitenin ve morbiditenin en önemli nedenleri arasında yer almaktadır. 80 yaşında kadın hasta göğüs ağrısı ile acil servisimize sevk edilmişti. Akut ST elevasyonlu inferior ve sağ miyokard enfarktüsü tanısıyla hasta primer şartlarda koroner anjiografiye alındı. Sağ koroner arterde yoğun ve uzun trombüs vardı. Bu nedenle hastaya perkütan koroner girişim düşünülmedi. Rutin antiagregan ve antikoagülan tedaviye bir glikoprotein IIb/IIIa reseptör blokeri olan tirofiban eklendi. 2 gün sonra yapılan kontrol koroner anjiografide rezidü trombüs ve lezyon izlenmedi. Mekanik reperfüzyona gereksinim olmadan, başarılı bir şekilde farmakolojik tedavi ile koroner reperfüzyon sağlandı. Hasta komplikasyonsuz bir şekilde medikal tedavisi düzenlenerek taburcu edildi. İnvaziv girişim yapmadan farmakolojik tedavi ile başarılı şekilde tedavi edilen bir olguyu sunmayı amaçladık

Anahtar Kelimeler:

Akut Miyokard Enfarktüsü, Trombüs, Tirofiban

Medical Therapy in Acute Myocardial Infarction: A Case Report

Acute ST elevation myocardial infarction is among the most important causes of cardiac mortality and morbidity. An 80-year-old female patient was referred to our emergency department with chest pain. The patient, who had been diagnosed with ST elevation inferior and right myocardial infarction, received coronary angiography under primary conditions. There was an intense and long thrombus in the right coronary artery. Therefore, the patient was not considered for percutaneous coronary intervention. Glycoprotein IIb/IIIa receptor blockers and tirofiban were added to antiaggregant and anticoagulant therapy. 2 days later, control coronary angiography did not show any signs of residual thrombus and lesions. Coronary reperfusion was achieved successfully with pharmacological treatment without the requirement of mechanical reperfusion. The patient was discharged without complications with further instructions to regulate the medical treatment. In this paper, we aim to present a case which we successfully treated through pharmacological treatment without the need for an invasive intervention.Key Words: Acute Myocardial Infarction; Thrombus; Tirofiban.

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Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992;326:242-50.
Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. Jama 1999;282:2035-42.
De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F. Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J. 2008;29:3002-10.
Boersma E, Harrington EA, Moliterno DJ, White H, Simoons ML. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a metaanalysis of all major randomised clinical trials. Lancet 2002;359(9302):189-98.
Yagmur J, Cansel M, Acikgoz N, Yagmur M, Eyupkoca F, Ermis N, et al. Multivessel coronary thrombosis in a patient with idiopathic thrombocytopenic purpura. Tex Heart Inst J. 2012;39(6):881-3.
Falk E, Shah PK, Fuster V. Coronary plaque dispruption. Circulation 1995;92(3):657-71.
Kotani J, Nanto S, Mintz GS, Kitakaze M, Ohara T, Morozumi T, et al. Plaque gruel of atheromatous coronary lesion may contribute to the no-reflow phenomenon in patients with acute coronary syndrome. Circulation 2002;106:1672-7.
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundquist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Euro Heart J. 2012;33:2569-619.
Echavarria-Pinto M, Loges R, Gorqadze T, Gonzalo N, Hemendez R, Jimenez Quevedo P, et al. Safety and Efficacy of Intense Antithrombotic Treatment and Percutaneous Coronary Intervention Deferral in Patients With Large Intracoronary Thrombus. Am J Cardiol 2013;111(12):1745-50.
Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 2000;101(2):125-30.