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Abciximab improves 6-month clinical outcome after rescue coronary angioplasty
Anna Sonia Petronio1, Giuseppe Musumeci, Ugo Limbruno
1Cardiothoracic Department, University of Pisa, Ospedale Cisanello, Pisa, Italy. a.petronio@mail.ao-pisa.toscana.it
Insights
Abciximab improves left ventricular function and reduces major adverse cardiac events in patients undergoing rescue percutaneous transluminal coronary angioplasty after failed thrombolysis for acute myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Limited data exist on abciximab's impact in rescue percutaneous transluminal coronary angioplasty (PTCA) post-failed thrombolysis for acute myocardial infarction (AMI).
- Assessing clinical outcomes and left ventricular function is crucial in this high-risk patient population.
Purpose of the Study:
- To evaluate the effects of abciximab on clinical outcomes and left ventricular function.
- To determine the safety and efficacy of abciximab in patients undergoing rescue PTCA for AMI.
Main Methods:
- Prospective randomized trial of 89 patients undergoing rescue PTCA within 24 hours of chest pain onset.
- Patients were randomized to receive abciximab (44) or placebo (45) before the procedure.
- Primary endpoints included major adverse cardiac events (MACE) at 30 days and 6 months, and periprocedural bleeding.
Main Results:
- Rescue PTCA success rate was 96% with no significant difference in bleeding between groups.
- Abciximab group showed significantly improved left ventricular wall motion score index at 30 days (P <.001).
- At 6 months, MACE incidence was significantly lower in the abciximab group (11% vs. 38%, P =.004).
Conclusions:
- Abciximab administration during rescue PTCA improves clinical outcomes at 6 months.
- The treatment positively affects left ventricular function without increasing bleeding risk.
- Abciximab is an independent predictor of reduced MACE in this setting.
Background:
Few data are available concerning the effects on clinical outcome and left ventricular function of abciximab administration in patients undergoing rescue percutaneous transluminal coronary angioplasty (PTCA) after failed thrombolysis for acute myocardial infarction. The aim of the study was to investigate such effects.
Methods:
Eighty-nine consecutive patients referred to our laboratory from other hospitals for rescue PTCA within 24 hours from the onset of chest pain were prospectively randomized before the procedure to abciximab treatment (44 patients) or placebo (45 patients). No significant differences in baseline characteristics were observed between the 2 groups. Study end points were the occurrence of major adverse cardiac events (MACE) such as death, reinfarction, congestive heart failure, target lesion revascularization, or recurrent ischemia at 30-day and 6-month follow-up and the occurrence of periprocedural bleeding.
Results:
Mean time from symptom onset to reperfusion was 8.5 +/-5.4 hours; rescue PTCA was successful in 96% of patients. The incidence of major, moderate, and minor bleeding was similar in the 2 groups. At 30-day follow-up, the echocardiographic left ventricular wall motion score index showed a significantly higher improvement in the abciximab group versus the placebo group (P <.001). At 6-month follow-up, the incidence of MACE was 11% in the abciximab group versus 38% in the placebo group (P =.004). Abciximab administration (P =.003) and cardiogenic shock (P =.005) were the only independent predictors of the occurrence of MACE at multivariable analysis.
Conclusion:
Treatment with abciximab during rescue PTCA positively affects clinical outcome at 6-month follow-up without increasing periprocedural bleeding.
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