Use of c7E3 Fab in conjunction with primary coronary stenting for acute myocardial infarctions complicated by cardiogenic shock

Although use of thrombolytic therapy during primary angioplasty is controversial, the development of a monoclonal antibody (c7E3 Fab) to the platelet glycoprotein IIb/IIIa receptor has been a tremendous breakthrough in the field of interventional cardiology. Use of the antibody during high-risk angioplasty or atherectomy procedures has been shown to significantly reduce the incidence of death, MI, or emergent repeat revascularization. We describe four cases in which c7E3 Fab was used as an adjunct to coronary stenting in the peri-infarct period in patients with cardiogenic shock. To our knowledge, no other reports have addressed the use of glycoprotein IIb/IIIa receptor inhibitors with coronary stent implantation. Our experience in this small population suggests that coronary stenting for myocardial infarctions may be a feasible option in selected patients to allow maximal luminal dilation and successful reperfusion. We emphasize that our results are preliminary, and we eagerly await the results of the EPILOG study which will provide more definitive data on the safety and efficacy of c7E3 Fab and coronary stenting from the perspective of a large, randomized trial.