title: Use and efficacy of abciximab in an unselected population with acute myocardial infarction treated with primary angioplasty: data from AMI-Florence registry.
abstract: OBJECTIVE
  We sought to evaluate the determinants and the potential benefit of abciximab use in unselected patients with acute myocardial infarction treated with primary angioplasty.
  
  
  RESULTS
  Based on the AMI-Florence registry, we analyzed 461 consecutive acute myocardial infarction patients treated with primary angioplasty, 280 (61%) of whom received abciximab. For each patient, a propensity score indicating the likelihood of abciximab treatment was calculated. Compared to those not treated, patients treated with abciximab were at lower risk. At multivariate analysis, the direct admission to a hospital with angioplasty facilities significantly increased the probability of receiving abciximab (OR 1.99, 95% CI 1.30-3.03, p=.001), while older age (OR 0.97, 95% CI 0.95-0.98, p<.0001), non-anterior location (OR 0.58, 95% CI 0.38-0.88, p=.011) and Killip class >1 (OR 0.53, 95% CI 0.32-0.87, p=.013), were negative predictors of abciximab use. Primary angioplasty had a higher success rate in patients treated with abciximab (99.3% versus 96.5%, p=.03). In-hospital and 1-year mortality were significantly lower in patients treated with abciximab (2.5% versus 13.3%, p<.0001, and 7% versus 21%, p<.0001, respectively). At multivariate analysis patients treated with abciximab had a significantly lower risk of in-hospital mortality (OR 0.35, 95% CI 0.14-0.93, p=.035), and a marginally lower risk of death at 1-year follow-up (HR 0.58, 95% CI 0.32-1.03, p=.065). These results did not change when the propensity score was included into the analyses.
  
  
  CONCLUSIONS
  In the real practice, abciximab is more frequently used in patients at lower risk, particularly when directly admitted to a hospital with angioplasty facilities. Abciximab use is associated with a significant reduction in early mortality. A trend toward a reduced mortality is maintained also at 1 year.
authors.affiliation: Agenzia Regionale di Sanit'a della Toscana, Azienda Sanitaria di Firenze, Azienda Ospedaliera Careggi, Florence, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Santoro
authors.forename: N
authors.initials: N
authors.lastname: Carrabba
authors.forename: A
authors.initials: A
authors.lastname: Barchielli
authors.forename: D
authors.initials: D
authors.lastname: Balzi
authors.forename: N
authors.initials: N
authors.lastname: Marchionni
authors.forename: M
authors.initials: M
authors.lastname: Filice
authors.forename: S
authors.initials: S
authors.lastname: Valente
authors.forename: M
authors.initials: M
authors.lastname: Granelli
authors.forename: I
authors.initials: I
authors.lastname: Berni
authors.forename: E
authors.initials: E
authors.lastname: Buiatti
mesh_terms: D000077284:Abciximab; D000208:Acute Disease; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy*; D016017:Odds Ratio; D012042:Registries; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab