Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation.
The impact of abciximab therapy on mortality in patients with acute myocardial infarction (AMI) who are undergoing infarct-related artery (IRA) stent implantation, which is complicated by cardiogenic shock (CS) due to predominant ventricular failure has not been established, whereas concluded randomized trials comparing IRA stenting plus abciximab with IRA stenting alone in patients with AMI have produced conflicting results. Moreover, these trials have excluded patients with CS from randomization. This study sought to determine whether IRA stenting plus abciximab treatment has an impact on 1-month mortality compared with IRA stenting alone in consecutive patients with AMI complicated by CS due to predominant ventricular failure. Of 77 patients with CS and IRA stenting, 44 had abciximab therapy, whereas 33 underwent primary IRA stenting alone. There were no differences between groups in major baseline characteristics except for a higher incidence of women in the stent alone group compared with the abciximab group (36% vs 14%, p = 0.020). The 1-month overall mortality rate was 18% in the abciximab group and 42% in the stent alone group (p <0.020). There were no differences between groups in reinfarction and target vessel revascularization rates. Multivariate analysis showed that abciximab therapy was the only variable that was independently related to 1-month mortality (odds ratio 0.36; 95% confidence intervals 0.15 to 0.86, p = 0.021). The results of this study support the use of abciximab in patients with AMI complicated by CS who are undergoing IRA stent implantation. The mechanism of the clinical benefit of abciximab at 1 month was not related to the patency of the IRA.
Antoniucci
David
D
Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
Valenti
Renato
R
Migliorini
Angela
A
Moschi
Guia
G
Trapani
Maurizio
M
Dovellini
Emilio V
EV
Bolognese
Leonardo
L
Santoro
Giovanni M
GM
D000077284:Abciximab; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000150:complications* / Q000401:mortality; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab