title: Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction. Observations from the TIMI 14 trial.
abstract: BACKGROUND
  In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation.
  
  
  RESULTS
  All 346 patients with interpretable baseline and 90-minute ECGs, treated with either tPA alone or abciximab plus reduced-dose tPA (combination therapy), were included. Patients receiving combination therapy (n=221) had a 59% rate of complete (>/=70%) ST resolution at 90 minutes versus 37% in those treated with tPA alone (n=125) (P<0.0001). When the analysis was limited to patients with TIMI 3 flow, patients treated with combination therapy (n=151) remained significantly more likely to achieve complete ST resolution than those receiving tPA alone (n=80) (69% versus 44%; P=0.0002).
  
  
  CONCLUSIONS
  Combination therapy with abciximab and reduced-dose tPA improves myocardial (microvascular) reperfusion, as reflected in greater ST-segment resolution, in addition to epicardial flow. This finding may translate into improved clinical outcomes by enhancing myocardial salvage.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston Massachusetts, USA. jdelemos@rics.bwh.harvard.edu
authors.forename: J A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: E M
authors.initials: EM
authors.lastname: Antman
authors.forename: C M
authors.initials: CM
authors.lastname: Gibson
authors.forename: C H
authors.initials: CH
authors.lastname: McCabe
authors.forename: R P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: S A
authors.initials: SA
authors.lastname: Murphy
authors.forename: S A
authors.initials: SA
authors.lastname: Coulter
authors.forename: K
authors.initials: K
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Scherer
authors.forename: M J
authors.initials: MJ
authors.lastname: Frey
authors.forename: R
authors.initials: R
authors.lastname: Van Der Wieken
authors.forename: F
authors.initials: F
authors.lastname: Van De Werf
authors.forename: E
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003326:Coronary Circulation / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010959:Tissue Plasminogen Activator; D000077284:Abciximab