Combination of Abciximab with Primary Stenting
Combination of Abciximab with Primary Stenting
Abciximab administration during primary coronary angioplasty in patients with acute myocardial infarction (AMI) reduces death, reinfarction, and the need for urgent target vessel revascularization (TVR). Stenting in AMI reduces the rate of repeat in-hospital TVR. There is limited information on the effectiveness and one-year clinical event rate of combined abciximab and primary stenting in patients with AMI at community hospitals. We evaluated the outcome of 40 consecutive patients treated with both abciximab and primary stenting at our institution. All patients underwent primary stenting of the infarct-related artery. All patients received abciximab, aspirin, ticlopidine, and heparin. TIMI grade 3 flow was established in all 40 patients. No patient required urgent TVR. There was no in-hospital reinfarction or cardiac-related death. All patients were followed for at least one year, and no patient died after hospital discharge. Thallium exercise stress test revealed no evidence of ischemia at 12-months follow-up. We conclude that combined abciximab and primary stenting in this series of patients with AMI was associated with excellent results.
The triggering event initiating acute myocardial infarction (AMI) is a rupture of the fibrous cap covering the atherosclerotic plaque and exposure of the highly thrombogenic substances within the plaque to the circulating blood. Primary percutaneous transluminal coronary angioplasty (PTCA), when performed early, has become the reperfusion therapy of choice in patients with AMI. However, approximately 10-15% of patients will develop spontaneous recurrent ischemia after successful PTCA for AMI.
Platelets play a major role in the initiation of ischemic complications after percutaneous coronary interventions. Abciximab, an inhibitor of the platelet membrane glycoprotein IIb/IIIa receptor, has been shown in several large clinical trials of percutaneous coronary interventions to reduce the 30-day incidence of death, nonfatal myocardial infarction, or need for urgent target vessel revascularization (TVR) by 40%. Aggressive platelet inhibition with abciximab during primary PTCA for AMI led to significant reduction in death, reinfarction, and urgent TVR in both the RAPPORT (ReoPro Primary PTCA Organization and Randomization Trial) and the EPIC (Evaluation of c7E3 for the Prevention of Ischemic Complication) trials.
In comparison with PTCA, primary stenting in patients with AMI reduced the rate of repeat in-hospital revascularization by 50% to 75%, from between 6% and 11% to between 2% and 4%. There is limited information on the effectiveness of combined abciximab and primary stenting in the setting of AMI. The purpose of this report is to describe our early and one-year outcome experience with combination of abciximab and primary stenting in patients with AMI.
Abciximab administration during primary coronary angioplasty in patients with acute myocardial infarction (AMI) reduces death, reinfarction, and the need for urgent target vessel revascularization (TVR). Stenting in AMI reduces the rate of repeat in-hospital TVR. There is limited information on the effectiveness and one-year clinical event rate of combined abciximab and primary stenting in patients with AMI at community hospitals. We evaluated the outcome of 40 consecutive patients treated with both abciximab and primary stenting at our institution. All patients underwent primary stenting of the infarct-related artery. All patients received abciximab, aspirin, ticlopidine, and heparin. TIMI grade 3 flow was established in all 40 patients. No patient required urgent TVR. There was no in-hospital reinfarction or cardiac-related death. All patients were followed for at least one year, and no patient died after hospital discharge. Thallium exercise stress test revealed no evidence of ischemia at 12-months follow-up. We conclude that combined abciximab and primary stenting in this series of patients with AMI was associated with excellent results.
The triggering event initiating acute myocardial infarction (AMI) is a rupture of the fibrous cap covering the atherosclerotic plaque and exposure of the highly thrombogenic substances within the plaque to the circulating blood. Primary percutaneous transluminal coronary angioplasty (PTCA), when performed early, has become the reperfusion therapy of choice in patients with AMI. However, approximately 10-15% of patients will develop spontaneous recurrent ischemia after successful PTCA for AMI.
Platelets play a major role in the initiation of ischemic complications after percutaneous coronary interventions. Abciximab, an inhibitor of the platelet membrane glycoprotein IIb/IIIa receptor, has been shown in several large clinical trials of percutaneous coronary interventions to reduce the 30-day incidence of death, nonfatal myocardial infarction, or need for urgent target vessel revascularization (TVR) by 40%. Aggressive platelet inhibition with abciximab during primary PTCA for AMI led to significant reduction in death, reinfarction, and urgent TVR in both the RAPPORT (ReoPro Primary PTCA Organization and Randomization Trial) and the EPIC (Evaluation of c7E3 for the Prevention of Ischemic Complication) trials.
In comparison with PTCA, primary stenting in patients with AMI reduced the rate of repeat in-hospital revascularization by 50% to 75%, from between 6% and 11% to between 2% and 4%. There is limited information on the effectiveness of combined abciximab and primary stenting in the setting of AMI. The purpose of this report is to describe our early and one-year outcome experience with combination of abciximab and primary stenting in patients with AMI.
