Impact of early abciximab administration on myocardial reperfusion in patients with ST-segment elevation myocardial infarction pretreated with 600 mg of clopidogrel before percutaneous coronary intervention

Abstract

Early rapid platelet inhibition with abciximab before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is suggested as beneficial. In previous studies on early abciximab administration clopidogrel was administered in cathlab in low loading dose. We investigated the role of early abciximab administration on top of early clopidogrel 600 mg loading dose in patients with STEMI treated with PPCI. A total of 73 non-shock STEMI < 6 h patients admitted to remote hospitals with anticipated delay to PPCI < 90 min were randomly assigned to three study groups--24 pts received abciximab before transfer to cathlab (early = group EA), 27 in cathlab during PPCI (late = group LA) and in 22 abciximab administration was left to operator's discretion during PPCI (selective = SA; given in 22.7% of patients). All patients received clopidogrel (600 mg), aspirin and heparin (70 U/kg) before transfer to cathlab. Angiography revealed more frequent infarct-related artery patency (TIMI 2 + 3: EA vs LA vs SA: 45.8 vs 18.5 vs 13.6%, P = 0.024), better myocardial tissue perfusion (MBG 2 + 3: EA vs LA vs SA: 45.8 vs 14.8 vs 13.6%, P = 0.02) in EA group in baseline angiography. There was no difference in these angiographic parameters and ECG ST-segment resolution after PPCI. In multivariate analysis early abciximab administration was an independent predictor of infarct-related artery patency in baseline angiography (OR 6.5; 95% CI 1.83-23.1; P = 0.004). Early abciximab administration before transfer for PPCI in patients with STEMI pretreated with 600 mg of clopidogrel results in more frequent infarct-related artery patency and better myocardial tissue perfusion before PPCI.

Efficacy and safety of early versus late glycoprotein IIb/IIIa inhibitors for PCI

“…1. Eleven trials was conducted on abciximab (n =2626, 62.4%) [11,20,21,[24][25][26][27][28][29][30][31], six trials on tirofiban (n =1165, 27.7%) [19,[32][33][34][35][36] and two trials on eptifibatide (n = 418, 9.9%) [37,38]. Study characteristics are summarized in Table 1.…”

“…A total of 895 patients in seven trials received oral administration of the loading dose of clopidogrel prior to PCI. Four trials were conducted on a loading dose of 600 mg (n =660, 73.7%) [19][20][21]24], one trial on a loading dose of 450 mg (n= 114, 12.7%) [32] and two trials on a loading dose of 300 mg (n = 121, 13.5%) [27,33].…”

“…Short-term mortality was available in two trials [24,31], at one month follow-up in 15 trials [19,20,[25][26][27][28][29][30][32][33][34][35][36][37][38], and at three month follow-up in one trial [11]. No significant reduction in shortterm mortality was observed with early abciximab (RR 1.00; 95% CI 0.69 to 1.43 P= 0.98) or SMGP (RR 1.57; 95% CI 0.89 to 2.77; P =0.12) (Fig.…”

“…8) administration. When clopidogrel was administered prior to PCI, abciximab was conducted in three trials [20,24,27] and SMGP in two trials [19,32]. No reduction in short-term mortality was observed with clopidogrel loading coupled with early abciximab (RR 0.74; 95% CI 0.15 to 3.61; P= 0.71) or SMGP (RR 1.33; 95% CI 0.54 to 3.24; P=0.54).…”

“…Adjunctive GpIIb/IIIa inhibitor in addition to clopidogel administration is currently recommended for the prevention of atherothrombotic events following PCI in the American College of Cardiology/American Heart Association practice guidelines [17]. However, clinical efficacy and bleeding risk of early versus late GpIIb/IIIa inhibitor with adequate clopidogel loading have not been clarified and several clinical trials have been too small to deduce meaningful conclusions [19][20][21].…”