Impact of early abciximab administration on infarct size in patients with ST-elevation myocardial infarction
Introduction
In patients with acute ST-elevation myocardial infarction (STEMI), our efforts to provide an effective myocardial reperfusion through primary percutaneous coronary intervention (PCI) are often frustrated by patient-related delay to presentation, and by logistical difficulties leading to prolonged door-to-balloon time. In order to anticipate the reperfusion of the infarct-related artery (IRA), different strategies of pharmacological facilitation of primary PCI have been evaluated.
Regarding facilitation with glycoprotein IIb/IIIa inhibitors, small randomized trials and a recent meta-analysis demonstrated that early abciximab administration improves coronary patency pre-PCI, myocardial perfusion post-PCI, and 1-month left ventricular function recovery [1], [2], [3]. However, in the large randomized FINESSE trial, facilitation with abciximab alone did not significantly improve the clinical outcomes [4].
Delayed-enhancement magnetic resonance imaging (DE-MRI) is currently the gold standard to assess myocardial tissue reperfusion. The aim of this randomized trial was to evaluate the effects of early vs. late abciximab administration on infarct size (IS) and microvascular obstruction (MVO) assessed by DE-MRI.
Section snippets
Population
We randomly assigned in an open-label fashion 110 consecutive patients with STEMI who needed ambulance transportation to undergo primary PCI to either early (i.e. in the emergency room) or late (i.e. in the catheterization laboratory) abciximab administration. After obtaining the qualifying ECG and the written informed consent from the patient, randomization was performed with a 1:1 ratio by an internet-based randomization system. Inclusion criteria were: (1) presence of ST-segment elevation ≥
Population
Of the 110 patients enrolled, 55 were randomized to early and 55 to late abciximab administration. The flow of participants through the study is represented in Fig. 2. A complete MRI assessment both at baseline and at 6-month follow-up was available in 44 patients in the Early group, and in 43 in the Late group.
The baseline clinical characteristics were similar between groups, except for a trend to a worse LV ejection fraction on admission in the Early group (Table 1). About 50% of patients in
Discussion
This randomized trial was planned to verify whether the early administration of abciximab before transportation to the catheterization laboratory is superior to the late administration in reducing IS, as assessed by DE-MRI at 6 months. We chose DE-MRI as the most sensitive method to assess IS in both the acute and chronic settings, allowing for precise quantification of the presence, location, and extent of myocardial infarction, and of microvascular obstruction [9], [15], [16], [17].
Our trial
Acknowledgments
We gratefully acknowledge A. Baratta (118 Network Massa), V. Bonatti (Massa Hospital), G. Casolo (Versilia Hospital), M. Cozzalupi (Fivizzano-Pontremoli Hospital), C. Giustarini (Volterra Hospital), R. Melandri (Emergency Department, Azienda Ospedaliero-Universitaria Pisana), A. Pucci (Carrara Hospital), G. Tartarini (Pontedera Hospital) for their cooperation.
The present trial was an academic research project which was partially supported by an unrestricted research grant from Eli Lilly and
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