Background When administered in conjunction with primary coronarystenting for the treatment of acute myocardial infarction, aplatelet glycoprotein IIb/IIIa inhibitor may provide additionalclinical benefit, but data on this combination therapy are limited.
Methods We randomly assigned 300 patients with acute myocardialinfarction in a double-blind fashion either to abciximab plusstenting (149 patients) or placebo plus stenting (151 patients)before they underwent coronary angiography. Clinical outcomeswere evaluated 30 days and 6 months after the procedure. Theangiographic patency of the infarct-related vessel and the leftventricular ejection fraction were evaluated at 24 hours and6 months.
Results At 30 days, the primary end point — a compositeof death, reinfarction, or urgent revascularization of the targetvessel — had occurred in 6.0 percent of the patients inthe abciximab group, as compared with 14.6 percent of thosein the placebo group (P=0.01); at 6 months, the correspondingfigures were 7.4 percent and 15.9 percent (P=0.02). The betterclinical outcomes in the abciximab group were related to thegreater frequency of grade 3 coronary flow (according to theclassification of the Thrombolysis in Myocardial Infarctiontrial) in this group than in the placebo group before the procedure(16.8 percent vs. 5.4 percent, P=0.01), immediately afterward(95.1 percent vs. 86.7 percent, P=0.04), and six months afterward(94.3 percent vs. 82.8 percent, P=0.04). One major bleedingevent occurred in the abciximab group (0.7 percent); none occurredin the placebo group.
Conclusions As compared with placebo, early administration ofabciximab in patients with acute myocardial infarction improvescoronary patency before stenting, the success rate of the stentingprocedure, the rate of coronary patency at six months, leftventricular function, and clinical outcomes.
Source Information
From the Division of Cardiology (G.M., R.C.), the Department of Anesthesiology, and the Mobile Intensive Care Unit (P.E.), Pitié–Salpêtrière Hospital, Paris; the Divisions of Cardiology, Beauregard Clinic, Marseilles (P.B.), Des Franciscaines Clinic, Nîmes (O.W.), Lagny–Marne-la-Vallée Hospital, Lagny-sur-Marne (S.E.), Les Fleurs Clinic, Ollioules (P.V.), Saint-Joseph Clinic, Colmar (J.-M.B.), Institut Cardiovasculaire Paris Sud, Antony (M.-C.M.), Trousseau Hospital, Tours (L.M.), and Henri Duffaut Hospital, Avignon (M.P.); and the Cardiovascular Therapeutic Unit, Eli Lilly, Saint-Cloud (P.P.) — all in France.
Address reprint requests to Dr. Montalescot at the Service de Cardiologie, Centre Hospitalier Universitaire Pitié–Salpêtrière, 47 Blvd. de l'Hôpital, 75013, Paris, France, or at gilles.montalescot{at}psl.ap-hop-paris.fr.
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