Abciximab restores the flow through a reoccluded coronary artery after failed thrombolysis and improves clinical status

Objective: To evaluate if abciximab restores the flow through the reoccluded infarct related artery (IRA) after thrombolysis, the result of urgent angioplasty and hemorrhagic risk.Design: A prospective pilot study.Setting: Intensive Care and Coronary Unit (ICCU), in a tertiary hospital with hemodynamic laboratory.Subjects: Patients admitted with acute myocardial infarction (AMI) and reocclusion of the IRA after thrombolysis.Interventions: Thrombolysis, abciximab administration and urgent stenting.Endpoints: Reperfusion of the IRA after abciximab administration and the rate of hemorrhagic events.Measurements and main results: Clinical and electrocardiographic criteria of IRA reperfusion and reocclusion were established. The times elapsed between different procedures, the Thrombolysis in Myocardial Infarction (TIMI) flow grade at the onset of coronary angiography and after stent placement, complications of the revascularization procedure and hemorrhagic events were recorded. Twenty patients were included, receiving thrombolysis because of AMI and showing reocclusion of the IRA in the first 48 hours. Abciximab was administered following IRA reocclusion. Coronary angiography was performed and a stent inserted when suitable. Some criteria of IRA reperfusion following abciximab treatment were present in 15 patients (75%). A TIMI flow grade 2–3 at the IRA was present in seven patients (35%) before stent placement. Earlier reocclusion was associated with a worse response to abciximab (p=0.049). Two (10%) IRA embolisms occurred. Hemorrhagic events were present in one patient (5%).Conclusions: Abciximab can restore the flow through the reoccluded IRA. Abciximab in combination with a thrombolytic agent has an acceptable risk of hemorrhagic complications.