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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Early abciximab administration before primary percutaneous coronary intervention improves infarct-related artery
Tomasz Rakowski1, Jaroslaw Zalewski, Jacek Legutko
12nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Insights
Administering abciximab before transfer for primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients improves artery patency and reduces infarct size. This early intervention leads to better left ventricular function and remodeling post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Guidelines recommend early abciximab for STEMI before PPCI.
- Evidence for pre-transfer abciximab use is limited.
- Study focuses on anterior wall STEMI patients with transfer delays.
Purpose of the Study:
- Investigate early abciximab administration's impact.
- Assess effects on reperfusion, infarct size, and cardiac function.
- Evaluate outcomes in STEMI patients awaiting PPCI.
Main Methods:
- 59 nonshock STEMI patients randomized.
- Early group received abciximab before transfer (n=27).
- Late group received abciximab before PPCI (n=32).
Main Results:
- Early group showed higher infarct-related artery patency (48% vs 20%).
- Improved ST-segment resolution (>50%) in the Early group (84% vs 56.7%).
- Lower enzymatic infarct size and better 30-day left ventricular remodeling in the Early group.
Conclusions:
- Early abciximab before PPCI enhances artery patency.
- Leads to improved myocardial perfusion and reduced infarct size.
- Results in better left ventricular function and remodeling at 30 days.
Background:
Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, the evidence supporting abciximab use before and during transfer for PPCI is limited. We investigated the effect of early abciximab administration on early reperfusion, ST-segment resolution, enzymatic infarct size, and left ventricular function in patients with first anterior wall STEMI.
Methods:
A total of 59 nonshock patients with STEMI admitted <12 hours to remote hospitals with anticipated delay to PPCI of <90 minutes were randomly assigned to 2 study groups: 27 patients received abciximab before transfer to catheterization laboratory (Early group), and 32 patients received abciximab immediately before PPCI (Late group).
Results:
Angiography revealed more frequent infarct-related artery patency in the Early group than in the Late group (TIMI 2 + 3: 48% vs 20%, P = .04). Better ST-segment resolution of >50% 60 minutes after PPCI was found in Early group than in the Late group (84% vs 56.7%, P = .04). The area under the curve for creatine kinase-MB indicated a significantly greater extent of myocardial injury in the Late group versus the Early group (8324 +/- 4185 vs 5938 +/- 3949 U/L . h, P = .04). There was a significant difference in the 30-day left ventricular end-systolic volume index (P = .02) and end-diastolic volume index (P = .05) in the echocardiography favoring the Early group.
Conclusions:
Early abciximab administration before transfer for PPCI in patients with first anterior wall STEMI results in more frequent infarct-related artery patency before PPCI, better myocardial tissue perfusion after PPCI, with lower enzymatic infarct size and lower degree of left ventricular remodeling during 30-day follow-up.
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