Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary
Julinda Mehilli1, Adnan Kastrati, Stefanie Schulz
1Deutsches Herzzentrum, Technische Universität, Munich, Germany. mehilli@dhm.mhn.de
Circulation
|April 1, 2009
Summary
Adding abciximab to clopidogrel did not reduce infarct size in ST-segment-elevation myocardial infarction patients. This study found no significant benefit in major adverse events or bleeding complications with abciximab use.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Abciximab, a glycoprotein IIb/IIIa receptor inhibitor, enhances primary percutaneous coronary interventions for acute myocardial infarction.
- The benefit of abciximab after clopidogrel loading in ST-segment-elevation myocardial infarction (STEMI) remains unclear.
Purpose of the Study:
- To determine if abciximab improves outcomes in STEMI patients already treated with clopidogrel.
- To assess the impact of abciximab on infarct size and major adverse cardiac events.
Main Methods:
- 800 STEMI patients within 24 hours of symptom onset, all on 600 mg clopidogrel, were randomized to abciximab or placebo.
- Infarct size was measured by SPECT using technetium-99m sestamibi before discharge.
- A composite of death, recurrent MI, stroke, or urgent revascularization was tracked at 30 days.
Main Results:
- Mean infarct size was 15.7% in the abciximab group versus 16.6% in the placebo group (P=0.47).
- The composite endpoint occurred in 5.0% of the abciximab group and 3.8% of the placebo group (P=0.40).
- Major bleeding complications occurred in 1.8% of patients in both groups.
Conclusions:
- Upstream abciximab administration does not reduce infarct size in STEMI patients receiving 600 mg clopidogrel.
- Abciximab did not show a significant benefit in reducing major adverse events or increasing bleeding risk in this patient population.
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