Efficacy of combination treatment with intracoronary abciximab and aspiration thrombectomy on myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary coronary stenting.
OBJECTIVE
We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


METHODS
We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5.


RESULTS
IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively).


CONCLUSIONS
Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Sung Gyun
SG
Ahn
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Seung-Hwan
SH
Lee
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Ji Hyun
JH
Lee
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jun-Won
JW
Lee
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Young Jin
YJ
Youn
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Min-Soo
MS
Ahn
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jang-Young
JY
Kim
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Byung-Su
BS
Yoo
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Junghan
J
Yoon
Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Kyung-Hoon
KH
Choe
Department of Cardiology, Ajou University Medical Center, Suwon, Korea.
Seung-Jea
SJ
Tahk
D000077284:Abciximab; D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D055815:Young Adult
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab
Abciximab; myocardial infarction; myocardial perfusion; thrombosuction