Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty - Results of the glycoprotein receptor antagonist patency evaluation (GRAPE) pilot study
Lfm. Van Den Merkhof et al., Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty - Results of the glycoprotein receptor antagonist patency evaluation (GRAPE) pilot study, J AM COL C, 33(6), 1999, pp. 1528-1532
Citations number
24
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES
We sought to study the effect of early infusion of abciximab on coronary pa
tency before primary angioplasty in patients with acute myocardial infarcti
on.
BACKGROUND
Glycoprotein IIb/IIIa antagonists have proved to be effective in reducing i
schemic events associated with coronary angioplasty. The present study expl
ores whether abciximab alone, without administration of thrombolytic therap
y, may induct reperfusion in patients with acute myocardial infarction.
METHODS
In the Glycoprotein Receptor Antagonist Patency Evaluation pilot study 60 p
atients with less than 6 h signs and symptoms of acute myocardial infarctio
n eligible for primary angioplasty received in the emergency room a bolus o
f abciximab 250 mu g/kg followed by a 12-h infusion of 10 mu g/min. All pat
ients were also treated with an oral dose of 160 mg aspirin and 5,000 IU of
heparin intravenously, As soon as possible a diagnostic angiography was pe
rformed to evaluate the patency of the infarct-related artery.
RESULTS
The median time between onset of symptoms and the administration of the abc
iximab bolus was 150 min (range 45 to 345), and the median time between abc
iximab bolus and first contrast injection in the infarct-related artery was
45 min (range 10 to 150). In 24 patients (40%, 95% confidence interval 28%
to 52%) Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 was
observed at a median time of 45 min (range 10 to 150) after abciximab bolu
s; TIMI flow grade 3 was observed in 11 patients (18%, 95% confidence inter
val 9% to 28%). There was no difference fn percentage of TIMI flow grade 2
or 3 between patients who received abciximab within 2.5 h after onset of sy
mptoms or thereafter.
CONCLUSIONS
Abciximab therapy given in the emergency room in patients awaiting primary
angioplasty is associated with full reperfusion (TIMI flow grade 3) in abou
t 20% and with TIMI flow grade 2 of 3 in about 40% of the patients at a med
ian time of 45 min. These figures are higher than those in primary angiopla
sty trials without such pretreatment. Randomized controlled trials of very
early infusion of abciximab, either prehospital or in-hospital, in patients
eligible far angioplasty are warranted. (C) 1999 by the American College o
f Cardiology.