Early versus periprocedural administration of abciximab for primary angioplasty: a pooled analysis of 6 studies.
BACKGROUND
The 2004 ACC/AHA guidelines on ST-elevation myocardial infarction state that it is reasonable to start treatment with abciximab as early as possible before primary percutaneous coronary intervention (PCI). We investigated the potential benefit of early use of abciximab by pooling data from all the available studies.


METHODS
Six prospective studies were identified that had allocated 260 patients to receive early abciximab (either prehospital or soon after the patient arrived in hospital) and 342 to receive late abciximab (at the time of PCI).


RESULTS
TIMI flow grade 2 or 3 was present in 42% of the early group compared with 29% in the late group (P = .001). After PCI, 59% of patients in the early group showed ST-resolution >or = 70%, compared with 41% in the late group (P = .003). The composite clinical outcomes death, new myocardial infarction, or repeat target vessel revascularization at 30 days occurred in 7.3% of the early group compared with 9.7% in the late group (odds ratio 0.73, 95% CI 0.41-1.32) and death alone occurred in 2.7% versus 4.7%, respectively (odds ratio 0.56, 95% CI 0.23-1.39).


CONCLUSIONS
Early administration of abciximab improves epicardial patency (TIMI flow) before PCI and results in better myocardial tissue perfusion (ST-resolution) after the procedure. The promising effects on clinical outcomes need to be tested in larger studies.
Gödicke
Jochen
J
Eli Lilly and Company, Critical Care Europe, Geneva, Switzerland. goedicke_jochen@lilly.com
Flather
Marcus
M
Noc
Marko
M
Gyöngyösi
Mariann
M
Arntz
Hans-Richard
HR
Grip
Lars
L
Gabriel
Henrique Mesquita
HM
Huber
Kurt
K
Nugara
Fiona
F
Schröder
Joachim
J
Svensson
Leif
L
Wang
Duolao
D
Zorman
Simona
S
Montalescot
Gilles
G
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab