Periprocedural abciximab administration in ST elevation myocardial infarction patients. Effect on severe microvascular obstruction beyond the restoration of epicardial coronary flow by primary angioplasty.
OBJECTIVE
The impact of periprocedural (before primary percutaneous coronary angioplasty, PCI) abciximab administration on microvascular obstruction in patients with occluded infarct-related artery (IRA) is unknown.


METHODS
We studied 36 consecutive patients with first ST elevation myocardial infarction (STEMI) and occluded IRA treated with successful primary PCI within 12 h from symptom onset, who received intravenous abciximab immediately before PCI and 49 matched patients who did not receive abciximab as controls. All patients underwent delayed-enhanced magnetic resonance (DE-MR) 6 +/- 2 days after PCI. Necrosis was judged as transmural when DE was extended to > or =75% of left ventricular (LV) segment thickness. Severe microvascular obstruction was identified as areas of late hypoenhancement surrounded by DE.


RESULTS
Time to treatment was comparable in the two groups (182 +/- 60 vs. 188 +/- 110 min, respectively). Transmurality and severe microvascular obstruction were present in 3.03 +/- 2.8 versus 3.09 +/- 2.9 (p = 0.9) and 1.05 +/- 1.5 versus 1.06 +/- 1.8 (p = 0.6) of LV segments, respectively, in the abciximab group versus controls. At multivariate analysis, severe microvascular obstruction was independently associated only with transmural necrosis (OR 1.5, p < 0.001) and age (OR 1.1, p = 0.02) but not with the use of abciximab.


CONCLUSIONS
Severe microvascular obstruction after primary PCI of STEMI patients with occluded IRA is related to transmural necrosis but not to the use of abciximab.
Tarantini
Giuseppe
G
Department of Cardiac, University of Padova, Padova, Italy. giuseppe.tarantini.1@unipd.it
Ramondo
Angelo
A
Corbetti
Francesco
F
Perazzolo Marra
Martina
M
Cacciavillani
Luisa
L
Napodano
Massimo
M
Bilato
Claudio
C
Razzolini
Renato
R
Iliceto
Sabino
S
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013997:Time Factors
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab