Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction - Observations from the TIMI 14 trial

Background-In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elev ation on a 12-lead ECG are at high risk for subsequent death and left ventr icular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study , combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combinati on of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevati on. Methods and Results-All 346 patients with interpretable baseline and 90-min ute ECGs, treated with either tPA alone or abciximab plus reduced-dose tPA (combination therapy), were included. Patients receiving combination therap y (n=221) had a 59% rate of complete (greater than or equal to 70%) ST reso lution at 90 minutes versus 37% in those treated with tPA alone (n=125) (P< 0.0001). When the analysis was limited to patients with TIMI 3 flow, patien ts treated with combination therapy (n=151) remained significantly more lik ely to achieve complete ST resolution than those receiving tPA alone (n=80) (69% versus 44%; P=0.0002). Conclusions-Combination therapy with abciximab and reduced-dose tPA improve s myocardial (microvascular) reperfusion, as reflected in greater ST-segmen t resolution, in addition to epicardial flow. This finding may translate in to improved clinical outcomes by enhancing myocardial salvage.