Platelet glycoprotein IIb/IIIa receptor inhibition in primary angioplasty for acute myocardial infarction: The new paradigm of direct revascularization

Acute myocardial infarction results from thrombotic occlusion superimposed on a ruptured athersoclerotic plaque. Immediate restoration of normal flow in the infarct-related artery can be achieved either with fibrinolytic or with direct mechanical revascularization. Primary PTCA has been shown to be superior to fibrinolytic therapy with respect to mortality, reinfarction, non-fatal stroke and length of hospitalization. Its results can be further improved by the addition of potent platelet inhibitors directed against the final common component of all stimuli for platelet aggregation, the glycoprotein (GP) IIb/IIIa receptor. In randomized clinical trials, primary angioplasty with adjunctive abciximab - a monoclonal antibody against the GP IIb/IIIa - was better than conventional primary angioplasty with heparin only. Abciximab use was associated with a significant reduction in reinfarction, need for urgent target vessel revascularization, microcirculatory dysfunction and regional left ventricular dysfunction as well as with a strong trend towards a reduction in mortality, even in patients receiving coronary stents.