title: Results of primary percutaneous transluminal coronary angioplasty plus abciximab with or without stenting for acute myocardial infarction complicated by cardiogenic shock.
abstract: This study examines the effects of abciximab as adjunctive therapy in primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) complicated by cardiogenic shock. Abciximab improves the outcome of primary PTCA for AMI, but its efficacy in cardiogenic shock remains unknown. Case report forms were completed in-hospital and follow-up was obtained by telephone, outpatient visit, and review of hospital readmission records. A total of 113 patients with cardiogenic shock from AMI were included. All underwent emergency PTCA during which abciximab was administered to 54 patients (48%). The 2 groups of patients who received and did not receive abciximab were similar at baseline. Coronary stents were implanted slightly more often in the abciximab group (59% vs 42%; p = 0.1). A significantly improved final TIMI flow, less no-reflow, and a decrease in vessel residual diameter stenosis occurred in the abciximab group. At 30-day follow-up, the composite event rate of death, myocardial reinfarction, and target vessel revascularization was better in the abciximab group (31% vs 63%; p = 0.002). The combination of abciximab and stents was synergistic and resulted in improvement of all components of the composite end point beyond that seen with each therapy alone. Thus, abciximab therapy improves the 30-day outcome of primary PTCA in cardiogenic shock, especially when combined with coronary stenting.
authors.affiliation: Division of Cardiology, Brigham & Women's Hospital and the Harvard University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Satyendra
authors.initials: S
authors.lastname: Giri
authors.forename: Joseph
authors.initials: J
authors.lastname: Mitchel
authors.forename: Rabih R
authors.initials: RR
authors.lastname: Azar
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Kiernan
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fram
authors.forename: Raymond G
authors.initials: RG
authors.lastname: McKay
authors.forename: Roger
authors.initials: R
authors.lastname: Mennett
authors.forename: Jonathan
authors.initials: J
authors.lastname: Clive
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Hirst
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab