Incidence, patient characteristics and predictors of aborted myocardial infarction in patients undergoing primary PCI: prospective study comparing pre- and in-hospital abciximab pretreatment

AIMS: This study was performed to assess the incidence, patient characteristics and predictors of aborted myocardial infarction (MI) in patients with ST-segment elevation MI (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: We enrolled 179 consecutive patients with STEMI within a fixed protocol for PPCI (Leiden MISSION! project); 90 patients received abciximab bolus in the hospital (in-hospital group) and 89 patients received abciximab bolus in the ambulance (pre-hospital group). Thirty-two patients (18%) fulfilled the criteria for an aborted MI. The incidence of aborted MI was four times higher in the pre-hospital abciximab group compared to the in-hospital group (OR = 4.2, 95% CI = 1.7-10.3). The median time between symptoms onset and abciximab bolus administration was significantly shorter in the aborted MI compared to established MI patients (70 vs. 115 min, p = 0.005). Multivariable analysis identified prehospital abciximab administration as the main predictor of aborted MI (OR = 2.86, 95% CI = 1.1-7.5). CONCLUSIONS: In patients with STEMI treated with PPCI, the incidence of aborted MI was 18%. Pre-hospital abciximab administration was the main predictor of aborted MI, and this effect was related to the initiation of treatment within the first two hours after symptoms onset and to the higher infarct related artery patency at presentation.