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Effect of Intravenous Abciximab on Coronary Flow Improvement After Re-vascularization in Primary Coronary
Ahmed N Rgeeb1, Hussein A Alsalkh2, Ali Kadhim Radhi3
1University of Kufa, Faculty of Medicine, Department of Internal Medicine, Najaf Cardiac Centre, Najaf, Iraq.
Insights
Intravenous Abciximab and intracoronary saline flush showed similar effects on coronary flow after primary percutaneous intervention for ST-elevation myocardial infarction. Neither treatment significantly impacted bleeding or in-hospital mortality in this study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Early diagnosis and management of ST-elevation myocardial infarction (STEMI) are crucial for restoring coronary blood flow via primary percutaneous intervention (PCI).
- Suboptimal myocardial reperfusion (slow or no-reflow) can occur despite successful revascularization, impacting patient outcomes.
- Glycoprotein IIb/IIIA inhibitors, such as Abciximab, are used in acute coronary syndromes, but their role in improving flow post-PCI needs further clarification.
Purpose of the Study:
- To evaluate the efficacy of intravenous Abciximab in improving coronary flow within 30 minutes in STEMI patients with suboptimal flow after primary PCI.
- To assess the impact of Abciximab on left ventricular function, re-infarction, and re-hospitalization rates.
- To compare the effects of intravenous Abciximab versus intracoronary saline flush on coronary flow and clinical outcomes.
Main Methods:
- A prospective, case-control study involving fifty STEMI patients randomly assigned to receive either intravenous Abciximab (n=25) or intracoronary saline flush (n=25).
- Coronary angiography was performed 30 minutes post-intervention to assess flow, alongside electrocardiogram (ECG) resolution, bleeding, and mortality monitoring.
- Clinical outcomes, including death, recurrent myocardial infarction, heart failure, stent thrombosis, and target vessel revascularization, were assessed at 30 days.
Main Results:
- No significant difference in coronary flow improvement or ECG resolution was observed between the Abciximab and saline flush groups within 30 minutes.
- Patients experiencing flow improvement showed significant ECG resolution, irrespective of treatment group or door-to-balloon time.
- Bleeding propensity and in-hospital mortality rates were comparable between the two groups.
Conclusions:
- Intravenous Abciximab and intracoronary saline flush demonstrate comparable efficacy in improving coronary flow post-primary PCI in STEMI patients.
- Both interventions were associated with minimal variations in bleeding complications and in-hospital mortality.
- The findings suggest that routine use of intravenous Abciximab may not offer additional immediate benefits for coronary flow in this specific patient population.
Introduction:
Of recognized fact the importance of early diagnosis and early management of ST-elevation myocardial infarction, to regain a normal or at least adequate coronary flow in the Primary Percutaneous Intervention. Slow or no-reflow is suboptimal myocardial reperfusion, without angiographic evidence of mechanical obstruction. Adenosine, Verapamil and saline flush are manoeuvres proved useful. The resolution of ST-segment is associated with successful revascularization and regarded as a predictor for future events. Glycoprotein IIB/IIIA inhibitors are a group of anti-platelets widely used in acute coronary syndrome.
Aim:
The aim of the study was to investigate that: uses of intra venous Abciximab, does not improve coronary flow in patients with MI that develop sub optimal flow after primary PCI within 30 minutes, but the improvement need 12 to 24 hour as founded in other studies, and its beneficial effect is related to early improvement in LV function and decrease of re-infarction and re-hospitalization.
Method:
Prospective, case-control study, enrolled fifty patients randomly assigned into two matching groups, first group (25 patients) received an intravenous Abciximab while the second group (25 patients) received intracoronary saline flush. Repeated angiography after 30 minutes, for immediate resultant flow assessment, Electrocardiographic changes resolution, bleeding and death. After a 30 days, a clinical assessment for primary outcome including, death, recurrent Myocardial infarction and Heart failure While the Secondary outcome including stent thrombosis, target vessel revascularization in addition to the primary outcome.
Result:
There was no significant difference in the flow Improvement and ECG resolution between both groups. These findings not affected by the door to balloon time. However, patients with flow improvement had a significant resolution in their ECG. Bleeding propensity and mortality were not significantly affected. Literatures proved the benefit of Abciximab in acute coronary syndrome.
Conclusion:
Both intravenous Abciximab and intracoronary saline flush had comparable effect on coronary flow improvement post primary percutaneous intervention, with minimal variation in the bleeding and in-hospital mortality.
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