title: Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trial.
abstract: BACKGROUND
  Patients with acute myocardial infarction might benefit from the addition of glycoprotein IIb/IIIa inhibitors to fibrinolytic or mechanical reperfusion strategies. We compared two strategies, stenting and fibrinolysis, both combined with abciximab, in terms of their ability to salvage myocardium in patients with acute myocardial infarction.
  
  
  METHODS
  We enrolled 162 patients with acute myocardial infarction within 12 h of onset of symptoms, assigning 81 stenting plus abciximab and 81 alteplase plus abciximab. Technetium-99m sestamibi scintigraphy was done at admission and after a median of 11 days to calculate initial perfusion defect, final infarct size, and degree of myocardial salvage. The primary endpoint was the salvage index (the ratio of the degree of myocardial salvage to the initial perfusion defect). Major adverse clinical events within 6 months from randomisation were also compared between the two treatments.
  
  
  RESULTS
  Paired scintigraphic measurements were available for 70 patients in the stent group and 71 in the alteplase group. Stenting was associated with greater myocardial salvage than alteplase (median 13.6% [IQR 5.9-23.9] vs 8.0% [2.5-16.0] of the left ventricle; p=0.007). Salvage index was greater in the stent group than in the alteplase group (median 0.60 [0.37-0.82] vs 0.41 [0.13-0.58]; p=0.001). The 6-month mortality rate was 5% (four deaths) in the stent group and 9% (seven deaths) in the alteplase group (relative risk 0.56 [95% CI 0.17-1.88]; p=0.35).
  
  
  CONCLUSIONS
  In patients with acute myocardial infarction, a reperfusion strategy based on stenting with abciximab produced more myocardial salvage than the combination of fibrinolysis plus abciximab. Larger studies are needed to assess whether these effects translate into clinical benefit.
authors.affiliation: Deutsches Herzzentrum, Technische Universität, Munich, Germany. kastrati@dhm.mhn.de
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Ullrich
authors.initials: U
authors.lastname: Schricke
authors.forename: Jodi
authors.initials: J
authors.lastname: Neverve
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.forename: Franz Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekolla
authors.forename: Rudolf
authors.initials: R
authors.lastname: Blasini
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D011877:Radionuclide Imaging; D016879:Salvage Therapy / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab