Restoration of coronary blood flow by single bolus injection of the GPIIb/IIIa receptor antagonist c7E3 Fab in a patient with acute myocardial infarction of recent onset

It has been debated that primary coronary angioplasty could be more effective if immediate antithrombotic therapy would contribute to a faster recanalization of the infarct-related artery. This is the first report of a patient who presented at the emergency department with acute anterolateral myocardial infarction, in whom a single bolus injection of c7E3 Fab (0.25 mg/kg body weight) led to complete reperfusion of the infarct-related coronary artery during organization time for planned acute coronary angioplasty. Pain relief 15 min after initiation of therapy and ST-segment resolution of >50%, as well as occurrence of idioventricular rhythm 30 min thereafter, were suggestive of successful recanalization before the coronary intervention was started. Diagnostic coronary angiography at 90 min revealed TIMI-grade 3 flow in the infarct-related coronary artery with only moderate luminal irregularities. BoIus administration of c7E3 Fab could be effective for dissolving platelet-rich thrombi in the early stage of acute myocardial infarction (AMI) and may therefore represent a promising "bridging" therapy in patients with AMI elected for primary coronary angioplasty.