Early abciximab administration before primary percutaneous coronary intervention improves infarct-related artery patency and left ventricular function in high-risk patients with anterior wall myocardial infarction: a randomized study.
BACKGROUND
Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, the evidence supporting abciximab use before and during transfer for PPCI is limited. We investigated the effect of early abciximab administration on early reperfusion, ST-segment resolution, enzymatic infarct size, and left ventricular function in patients with first anterior wall STEMI.


METHODS
A total of 59 nonshock patients with STEMI admitted <12 hours to remote hospitals with anticipated delay to PPCI of <90 minutes were randomly assigned to 2 study groups: 27 patients received abciximab before transfer to catheterization laboratory (Early group), and 32 patients received abciximab immediately before PPCI (Late group).


RESULTS
Angiography revealed more frequent infarct-related artery patency in the Early group than in the Late group (TIMI 2 + 3: 48% vs 20%, P = .04). Better ST-segment resolution of >50% 60 minutes after PPCI was found in Early group than in the Late group (84% vs 56.7%, P = .04). The area under the curve for creatine kinase-MB indicated a significantly greater extent of myocardial injury in the Late group versus the Early group (8324 +/- 4185 vs 5938 +/- 3949 U/L . h, P = .04). There was a significant difference in the 30-day left ventricular end-systolic volume index (P = .02) and end-diastolic volume index (P = .05) in the echocardiography favoring the Early group.


CONCLUSIONS
Early abciximab administration before transfer for PPCI in patients with first anterior wall STEMI results in more frequent infarct-related artery patency before PPCI, better myocardial tissue perfusion after PPCI, with lower enzymatic infarct size and lower degree of left ventricular remodeling during 30-day follow-up.
Rakowski
Tomasz
T
2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Zalewski
Jaroslaw
J
Legutko
Jacek
J
Bartus
Stanislaw
S
Rzeszutko
Lukasz
L
Dziewierz
Artur
A
Sorysz
Danuta
D
Bryniarski
Leszek
L
Zmudka
Krzysztof
K
Kaluza
Grzegorz L
GL
Dubiel
Jacek S
JS
Dudek
Dariusz
D
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013318:Stroke Volume; D013997:Time Factors; D014654:Vascular Patency / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab