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

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.