Facilitation of early percutaneous coronary intervention after reteplase with or without abciximab in acute myocardial infarction - Results from the SPEED (GUSTO-4 pilot) trial

OBJECTIVES We examined the utility of early percutaneous coronary intervent ion (PCI) in a trial that encouraged its use after thrombolysis and glycopr otein IIb/IIIa inhibition for acute myocardial infarction (MI). BACKGROUND Early PCI has shown no benefit when performed early after thromb olysis alone. METHODS We studied 323 patients (61%) who underwent PCI with planned initia l angiography, at a median 63 min after reperfusion therapy began. A blinde d core laboratory reviewed cineangiograms. Ischemic events, bleeding, angio graphic results, and clinical outcomes were compared between early PCI and no-PCI patients (n = 162), between patients with Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 before PCI Versus flow grade 2 or 3, a nd among three treatment regimens. RESULTS Early PCI patients showed a procedural success (<50% residual steno sis and TIMI flow grade 3) rate of 88%, and a 30-day composite incidence of death, reinfarction, or urgent revascularization of 5.6%. These patients h ad fewer ischemic events and bleeding complications (15%) than did patients not undergoing early PCI (30%, p = 0.001). Early PCI was used more often i n patients with initial TIMI flow grade 0 or 1 versus flow grade 2 or 3 (83 % vs. 60%, p < 0.0001). Patients receiving abciximab with reduced-dose rete plase (5 U double bolus) showed an 86% incidence of TIMI grade 3 flow at si milar to 90 min and a trend toward improved outcomes. CONCLUSIONS In this analysis, early PCI facilitated by a combination of abc iximab and reduced-dose reteplase was safe and effective. This approach has several advantages for acute MI patients, which should be confirmed in a d edicated, randomized trial. (C) 2000 by the American College of Cardiology.