title: Impact of early abciximab administration on myocardial reperfusion in patients with ST-segment elevation myocardial infarction pretreated with 600 mg of clopidogrel before percutaneous coronary intervention.
abstract: Early rapid platelet inhibition with abciximab before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is suggested as beneficial. In previous studies on early abciximab administration clopidogrel was administered in cathlab in low loading dose. We investigated the role of early abciximab administration on top of early clopidogrel 600 mg loading dose in patients with STEMI treated with PPCI. A total of 73 non-shock STEMI < 6 h patients admitted to remote hospitals with anticipated delay to PPCI < 90 min were randomly assigned to three study groups--24 pts received abciximab before transfer to cathlab (early = group EA), 27 in cathlab during PPCI (late = group LA) and in 22 abciximab administration was left to operator's discretion during PPCI (selective = SA; given in 22.7% of patients). All patients received clopidogrel (600 mg), aspirin and heparin (70 U/kg) before transfer to cathlab. Angiography revealed more frequent infarct-related artery patency (TIMI 2 + 3: EA vs LA vs SA: 45.8 vs 18.5 vs 13.6%, P = 0.024), better myocardial tissue perfusion (MBG 2 + 3: EA vs LA vs SA: 45.8 vs 14.8 vs 13.6%, P = 0.02) in EA group in baseline angiography. There was no difference in these angiographic parameters and ECG ST-segment resolution after PPCI. In multivariate analysis early abciximab administration was an independent predictor of infarct-related artery patency in baseline angiography (OR 6.5; 95% CI 1.83-23.1; P = 0.004). Early abciximab administration before transfer for PPCI in patients with STEMI pretreated with 600 mg of clopidogrel results in more frequent infarct-related artery patency and better myocardial tissue perfusion before PPCI.
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Kopernika 17 St, 31-501 Krakow, Poland. mcdudek@cyf-kr.edu.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Bartus
authors.forename: Dawid
authors.initials: D
authors.lastname: Giszterowicz
authors.forename: Wojciech
authors.initials: W
authors.lastname: Dobrowolski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Zalewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochala
authors.forename: Pawel
authors.initials: P
authors.lastname: Wieja
authors.forename: Bogdan
authors.initials: B
authors.lastname: Janus
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Jacek
authors.initials: J
authors.lastname: Legutko
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.forename: Jacek S
authors.initials: JS
authors.lastname: Dubiel
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000925:Anticoagulants; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab