In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: results from the Leiden MISSION! acute myocardial infarction treatment optimization program.
OBJECTIVE
Our aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short, and long term outcomes.


BACKGROUND
Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains indistinct.


METHODS
Within a fixed protocol for PPCI, December 2006 was the cut-off point for this prospective study. A total of 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (in-hospital group), and 89 patients received abciximab bolus in the ambulance (in-ambulance group).


RESULTS
The two groups were comparable for baseline and angiographic characteristics. The in-ambulance group received abciximab within the golden period (median 63 min). The infarct related artery (IRA) patency at onset of the PCI was four times higher in the in-ambulance group compared to in-hospital group (odds ratio = 4.9, 95% CI 2.4-10.1). Enzymatic infarct size was smaller in the in-ambulance group (cumulative 48-h CK release 8011 vs. 11267 U/L, P = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI measured by myocardial scintigraphy (59% vs. 54%, P = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs.11%, P = 0.04).


CONCLUSIONS
Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up.
Hassan
Ayman K M
AK
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Liem
Su San
SS
van der Kley
Frank
F
Bergheanu
Sandrin C
SC
Wolterbeek
Ron
R
Bosch
Jan
J
Bootsma
Marianne
M
Zeppenfeld
Katja
K
van der Laarse
Arnoud
A
Atsma
Douwe E
DE
Jukema
J Wouter
JW
Schalij
Martin J
MJ
D000077284:Abciximab; D000368:Aged; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D002985:Clinical Protocols; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D015994:Incidence; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000473:pathology*; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left / Q000187:drug effects*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab