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Abciximab and early adjunctive percutaneous coronary intervention are associated with improved ST-segment resolution
J A de Lemos1, C M Gibson, E M Antman
1Donald W. Reynolds Cardiovascular Clinical Research Center, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Room 8.116, Dallas, TX 75390-9034, USA. james.delemos@utsouthwestern.edu
Insights
Combination therapy with abciximab and reduced-dose thrombolytics, followed by percutaneous coronary intervention (PCI), significantly improved ST-segment resolution, indicating enhanced myocardial perfusion. This strategy may improve outcomes in patients with acute myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombolytic Therapy
Background:
- Percutaneous coronary intervention (PCI) benefits select patients post-thrombolysis, but its role after successful epicardial reperfusion remains unclear.
- Myocardial perfusion can be inadequate despite patent infarct-related arteries.
- Evaluating a reperfusion strategy combining abciximab with reduced-dose thrombolytics followed by early PCI is crucial.
Purpose of the Study:
- To assess if a reperfusion regimen including abciximab and reduced-dose thrombolytics, followed by early adjunctive PCI, improves myocardial perfusion.
- To evaluate myocardial perfusion using ST-segment resolution as a primary endpoint.
Main Methods:
- 410 patients from the TIMI 14 trial with evaluable electrocardiograms were analyzed.
- Patients received either combination therapy (abciximab + reduced-dose thrombolytic) or full-dose thrombolytic alone.
- ST resolution was measured between 90 and 180 minutes post-therapy, with or without adjunctive PCI.
Main Results:
- Adjunctive PCI after combination therapy significantly increased ST resolution (54% vs 8%, P=.002) in patients undergoing PCI.
- In patients with TIMI grade 3 flow at 90 minutes, combination therapy with PCI improved ST resolution (57% vs 24%, P=.006), unlike thrombolytic therapy alone (1% vs 10%, P=.70).
- Abciximab treatment was independently associated with greater ST resolution (P=.008) in multivariate analysis.
Conclusions:
- A reperfusion strategy using abciximab and early adjunctive PCI enhances ST-segment resolution.
- This improvement suggests improved tissue-level and microvascular perfusion.
- Prospective studies are warranted to confirm the clinical efficacy of this combined strategy.
Background:
Percutaneous coronary intervention (PCI) improves clinical outcomes in selected patients with failed thrombolysis but has not been proven to benefit patients who achieve a patent infarct-related artery. Even after successful epicardial reperfusion, myocardial perfusion may be inadequate. We sought to evaluate whether a strategy that uses a reperfusion regimen containing abciximab and a reduced-dose thrombolytic agent (combination therapy), followed by early adjunctive PCI, would result in improved myocardial perfusion, as assessed by ST-segment resolution.
Methods:
ST resolution from 90 to 180 minutes after therapy was calculated for all 410 patients from the TIMI 14 trial who had evaluable electrocardiograms at both time points and who were treated with alteplase or reteplase. Patients were grouped according to whether they were treated with combination therapy or full-dose thrombolytic agent alone and whether they underwent PCI between the 90- and 180-minute electrocardiographic measurements.
Results:
Among 105 patients who underwent adjunctive PCI between 90 and 180 minutes, mean ST resolution from 90 to 180 minutes was significantly greater in those who had received combination therapy versus those who had received full-dose thrombolytic alone (54% vs 8%; P =.002). Among 241 patients with TIMI grade 3 flow in the infarct-related artery at 90 minutes, adjunctive PCI significantly improved mean ST resolution in patients who had been treated with combination therapy (57% [PCI] vs 24% [no PCI]; P =.006), but PCI did not have this effect in patients who had received thrombolytic therapy alone (1% [PCI] vs 10% [no PCI]; P =.70). In a multivariate model controlling for factors that would be expected to independently influence 90- to 180-minute ST resolution, abciximab treatment remained significantly associated with greater ST resolution (P =.008).
Conclusions:
A strategy that uses a combination reperfusion regimen that includes abciximab, followed by early adjunctive PCI, is associated with greater ST-segment resolution, which may reflect enhanced tissue level and microvascular perfusion. Future studies should evaluate prospectively the clinical efficacy of this strategy.