title: Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction.
abstract: BACKGROUND
  As compared with thrombolytic therapy, primary percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction reduces the rates of death, reinfarction, and stroke, but recurrent ischemia, restenosis, and reocclusion of the infarct-related artery remain problematic. When used in combination with PTCA, coronary stenting and platelet glycoprotein IIb/IIIa inhibitors may further improve outcomes.
  
  
  METHODS
  Using a 2-by-2 factorial design, we randomly assigned 2082 patients with acute myocardial infarction to undergo PTCA alone (518 patients), PTCA plus abciximab therapy (528), stenting alone with the MultiLink stent (512), or stenting plus abciximab therapy (524).
  
  
  RESULTS
  Normal flow was restored in the target vessel in 94.5 to 96.9 percent of patients and did not vary according to the reperfusion strategy. At six months, the primary end point - a composite of death, reinfarction, disabling stroke, and ischemia-driven revascularization of the target vessel - had occurred in 20.0 percent of patients after PTCA, 16.5 percent after PTCA plus abciximab, 11.5 percent after stenting, and 10.2 percent after stenting plus abciximab (P<0.001). There were no significant differences among the groups in the rates of death, stroke, or reinfarction; the difference in the incidence of the primary end point was due entirely to differences in the rates of target-vessel revascularization (ranging from 15.7 percent after PTCA to 5.2 percent after stenting plus abciximab, P<0.001). The rate of angiographically established restenosis was 40.8 percent after PTCA and 22.2 percent after stenting (P<0.001), and the respective rates of reocclusion of the infarcted-related artery were 11.3 percent and 5.7 percent (P=0.01), both independent of abciximab use.
  
  
  CONCLUSIONS
  At experienced centers, stent implantation (with or without abciximab therapy) should be considered the routine reperfusion strategy.
authors.affiliation: Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York, NY 10022, USA. gstone@crf.org
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Eulogio
authors.initials: E
authors.lastname: Garcia
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: John J
authors.initials: JJ
authors.lastname: Griffin
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Thomas
authors.initials: T
authors.lastname: Stuckey
authors.forename: Mark
authors.initials: M
authors.lastname: Turco
authors.forename: John D
authors.initials: JD
authors.lastname: Carroll
authors.forename: Barry D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
mesh_terms: D000077284:Abciximab; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D020521:Stroke
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab