Key result
Periprocedural intravenous abciximab administration before primary PCI in STEMI patients was not associated with a reduction in severe microvascular obstruction (1.05 vs 1.06 LV segments; p=0.6).
Why the study?
Does intravenous abciximab immediately before primary PCI reduce microvascular obstruction in patients with first STEMI and occluded IRA?
Observational (n=85)
Does intravenous abciximab immediately before primary PCI reduce microvascular obstruction in patients with first STEMI and occluded IRA?
Absolute Event Rate: 1.05% vs 1.06%
p-value: p=0.6
Periprocedural intravenous abciximab administration does not reduce severe microvascular obstruction assessed by MRI in STEMI patients with an occluded infarct-related artery undergoing primary PCI.
No reduction in microvascular obstruction with pre-PCI abciximab; leaves open any selective benefit in STEMI pending randomized trials.
OBJECTIVES: 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.
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Tarantini et al. (2007) conducted an observational in ST elevation myocardial infarction (STEMI) (n=85). Abciximab vs. No abciximab was evaluated on Severe microvascular obstruction (number of LV segments) (p=0.6). Periprocedural intravenous abciximab administration before primary PCI in STEMI patients was not associated with a reduction in severe microvascular obstruction (1.05 vs 1.06 LV segments; p=0.6).
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