Abciximab therapy improves 1-month survival rate in unselected patients with acute myocardial infarction undergoing routine infarct artery stent implantation.
BACKGROUND
The impact of abciximab therapy on mortality in unselected patients with acute myocardial infarction (AMI) undergoing routine primary infarct-related artery (IRA) stent implantation is not yet defined, and previous randomized studies have produced conflicting results.


METHODS
A strategy of IRA stenting alone as opposed to IRA stenting plus abciximab was compared in a series of 561 consecutive unselected patients with AMI. Abciximab treatment was strongly encouraged for all patients. The contraindication for abciximab therapy was a high risk of major bleeding as assessed by the operator before mechanical intervention.


RESULTS
Of 561 patients, 348 patients underwent abciximab therapy and 213 underwent primary IRA stenting alone. The 1-month overall mortality rate was 2.9% in the abciximab group and 10.8% in the stent alone group (P <.001). The relative reduction in mortality rate was 73% for patients overall, 77% in the subset of patients aged < or =70 years (mortality rate, 1.2% vs 5.2%, P =.020), 57% in patients aged >70 years (7.7% vs 18%, P =.043), 63% in patients with cardiogenic shock (17% vs 46%, P =.022), and 77% in patients without cardiogenic shock (1.3% vs 5.6%, P =.002). Multivariate analyses on the basis of all patients, and on the subset of patients aged < or =70 years, showed that abciximab therapy was independently related to the risk of death at 1 month. No differences were seen between groups in the procedural success rate (99.1% vs 98.1%) or in the incidence rates of nonfatal reinfarction (0.3% vs 1.9%) or repeat target vessel revascularization (1.7% vs 1.9%).


CONCLUSIONS
The results of this study strongly support the use of abciximab therapy in nonselected patients with AMI undergoing routine IRA stent implantation. The mechanism of the clinical benefit of abciximab was not related to the patency of the IRA.
Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
David
D
Antoniucci
Renato
R
Valenti
Angela
A
Migliorini
Guia
G
Moschi
Maurizio
M
Trapani
Piergiovanni
P
Buonamici
Giampaolo
G
Cerisano
Leonardo
L
Bolognese
Giovanni Maria
GM
Santoro
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage; D015331:Cohort Studies; D000075202:Contraindications; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D012044:Regression Analysis; D015607:Stents; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab