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Effects of abciximab as adjunctive therapy in primary percutaneous coronary intervention patients (results from the
Maria Sejersten1, Charles Maynard, Peter Clemmensen
1The Heart Centre, Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark. msejersten@webspeed.dk
Insights
Abciximab use during primary percutaneous coronary intervention (pPCI) showed improved microvascular reperfusion but increased disabling stroke risk. While reducing re-infarction, the overall benefit requires careful consideration of stroke complications in acute myocardial infarction patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Microvascular reperfusion is critical following acute myocardial infarction (AMI) but often suboptimal despite epicardial reperfusion.
- Therapies targeting 'no-flow' phenomena are crucial in patients undergoing primary percutaneous coronary intervention (pPCI) for AMI.
Purpose of the Study:
- To evaluate if abciximab, as an adjunct to pPCI, improves ST-segment resolution, a surrogate for microvascular reperfusion.
- To assess the impact of abciximab on clinical prognosis, including death, re-infarction, and disabling stroke.
Main Methods:
- Analysis of the DANAMI-2 trial data, including 309 patients treated with pPCI and abciximab at physician discretion.
- Measurement of ST-segment elevation at various time points post-pPCI to assess resolution (Complete, Partial, No).
- Clinical endpoints evaluated: death, re-infarction, and disabling stroke.
Main Results:
- Abciximab use was associated with more pronounced partial ST-segment resolution at 4 and 12 hours post-pPCI.
- Patients receiving abciximab had significantly lower rates of re-infarction at 30 days (0% vs. 2.8%).
- A significant increase in disabling stroke rates was observed in the abciximab group (2.3% vs. 0.4%).
Conclusions:
- Abciximab, in conjunction with pPCI, suggests improved microvascular reperfusion, indicated by enhanced partial ST-segment resolution.
- The reduction in re-infarction rates with abciximab was counterbalanced by an increased risk of disabling stroke.
- The study highlights a complex risk-benefit profile for abciximab in AMI patients treated with pPCI.
Introduction:
Successful reperfusion at the epicardial level is not always accompanied by reperfusion of the microvasculature. Therapies targeted against 'no-flow' are often employed in patients receiving primary percutaneous coronary intervention (pPCI) after acute myocardial infarction.
Hypothesis:
Abciximab as adjunctive to pPCI will improve ST-segment resolution used as a surrogate for optimal microvascular reperfusion, and improve prognosis.
Methods:
In the DANAMI-2 trial 309/790 (39%) patients treated with pPCI received abciximab at physician discretion. SigmaST-segment elevation at baseline, 90 min, 4 h, 12 h, 24 h after pPCI and at discharge was measured and ST-segment resolution grouped as: Complete (> or = 70 %); Partial (> or = 30 to < 70%); No (< 30%). Clinical endpoints were death, re-infarction and disabling stroke.
Results:
Abciximab prescription varied from 24.4-60.3% in the different hospitals. Patients receiving abciximab had a higher risk profile. ST-segment resolution at 90 min and 24 h was identical in the two groups, but at 4 h and 12 h partial ST-segment resolution was more pronounced in patients receiving abciximab (P = 0.001, P = 0.026). In a multivariate analysis, adjusting for baseline differences abciximab was associated with improved partial ST-segment resolution at 12 h. Patients treated with abciximab had no re-infarction at 30 days (0% versus 2.8%, P = 0.003), but increased disabling stroke rate (2.3% versus 0.4%; P = 0.019) driven by cerebral infarctions, and not intracranial hemorrhage. There were no differences in death rates.
Conclusions:
In the DANAMI-2 trial with no age limit, the decreased re-infarction rates in patients receiving abciximab was offset by increased disabling stroke rates. Abciximab in conjunction with pPCI is associated with more pronounced partial ST-segment resolution after 4 h to 12 h suggesting improved microvascular reperfusion.
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