title: Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine.
abstract: BACKGROUND
  Primary angioplasty is the best treatment of acute myocardial infarction but fails to achieve adequate myocardial reperfusion in 25% to 30% of patients, despite TIMI grade 3 flow. Drug treatment aimed at reducing the no-reflow phenomenon may improve myocardial salvage, thus preventing left ventricular remodeling. Our aim was to evaluate the impact of abciximab and adenosine on immediate angiographic results and on 6-month left ventricular remodeling.
  
  
  METHODS
  Ninety consecutive patients undergoing primary angioplasty with coronary stenting were randomized in a sequential alternating fashion to standard abciximab treatment (ABCX) group, intracoronary adenosine distal to the occlusion (ADO) group, or neither (CTRL) group. All patients underwent a clinical and echocardiographic follow-up at 1 and 6 months. The primary end point was the prevalence of 6-month left ventricular remodeling.
  
  
  RESULTS
  Baseline clinical, echocardiographic, and angiographic characteristics were similar. Mean final corrected TIMI frame count was 17 +/- 9, 16 +/- 12, and 23 +/- 11 frames in ABCX, ADO, and CTRL patients, respectively (P = .002). Angiographic no-reflow was observed in 7%, 13%, and 17% of ABCX, ADO, and CTRL patients, respectively (P > .20). At 6 months, left ventricular remodeling occurred in 7%, 30%, and 30% of ABCX, ADO, and CTRL patients, respectively (P = .045), with a percent increase in end-diastolic volume of 5% +/- 13%, 15% +/- 15%, and 12% +/- 18% (P = .04).
  
  
  CONCLUSIONS
  During primary angioplasty, abciximab enhances myocardial reperfusion, translating into a reduced incidence of 6-month left ventricular remodeling. In contrast, adenosine administration improves angiographic results but does not prevent left ventricular remodeling.
authors.affiliation: CardioThoracic Department, University of Pisa, Pisa, Italy. a.petronio@ao-pisa.toscana.it
authors.forename: Anna S
authors.initials: AS
authors.lastname: Petronio
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Nicola
authors.initials: N
authors.lastname: Ciabatti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amoroso
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.forename: Caterina
authors.initials: C
authors.lastname: Palagi
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Maria F
authors.initials: MF
authors.lastname: Romano
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
mesh_terms: D000077284:Abciximab; D000241:Adenosine / Q000008:administration & dosage*; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003331:Coronary Vessels; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020257:Ventricular Remodeling
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D000241:Adenosine; D000077284:Abciximab