الفهرس 
Acute myocardial infarctionOnly 14 pages are availabe for public view
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Abstract
Acute occluding of major epicardial coronary artery usually leading to acute STEMI. Successful recanalization and patency of the occluded vessels by percutaneous coronary intervention (PCI) or fibrinolytic diminishes the infarction size, save the function of ventricle and decrease morbidity and mortality.
Several consequences such as no-flow and slow-flow, associated with more major adverse cardiac events (MACE), complications and high mortality, have been observed in patients with DM complicated by acute MI (AMI) and undergoing primary PCI . Platelet aggregation into the distal microvasculature or thrombus embolization after immediately successful intervention impair microvascular flow. Glycoprotein IIb/IIIa inhibitors (GPI) administration and many catheter based strategies have been submitted to overcome this phenomenon .
The study evaluated 95 consecutive diabetic patients undergoing primary PCI for ST elevation myocardial infarction (STEMI). Patients were recruited to receive either intravenous (group A: n = 50) or intracoronary (group B: n = 45) 25 micg/kg tirofiban bolus and maintenance dose of 0.15 μg /kg/min infusion for 24 hours.
We included adult patients less than 75 years and ≥ 18 years old with clinical presentation of STEMI and specific ECG criteria in the form of ST-segment elevation ≥ 1 mm in ≥ 2 contiguous leads except v2 and v3 must be ≥ 1.5 mm in females , ST-segment elevation ≥ 2.5 mm in male less than 40 years or ≥ 2 mm in male more than 40 years or presence of new-onset or presumed new left bundle branch block .
Patients with marked uncontrolled hypertension (≥ 180/110 mmHg), rescue PCI and emergency coronary artery bypass grafting were excluded. Other exclusion criteria included patients presented with cardiogenic shock, severe liver or kidney failure, bleeding diathesis, hypersensitivity, or thrombocytopenia with tirofiban, platelets <150,000/cu.mm, Active internal bleeding history ischemic or hemorrhagic stroke within last 30 days, AV malformation or aneurysm, neoplasm aortic dissection, acute pericarditis, hemorrhagic retinopathy and chronic hemodialysis.
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In both groups, bolus 25 μg /kg of tirofiban was given immediately after guidewire crossed the lesion successfully and ante grade flow was restore aiming to secure m