Assessment of early administration of abciximab in acute ST-segment elevation myocardial infarction in the emergency room

Abstract

Abciximab, a platelet glycoprotein IIb/IIIa inhibitor, administered in conjunction with primary coronary stenting, improves the outcome of acute myocardial infarction, and the earlier it is administered, the greater the improvement. We sought to assess the feasibility of early administration of abciximab in the emergency room (ER) before primary coronary stenting and compare our results with those of a group of patients treated in the prehospital (ambulance) phase. Data and outcome of patients with acute ST-segment elevation myocardial infarction who received abciximab (0.25 mg x kg(-1) then 0.125 mg x kg(-1) x h(-1)) in the ER before primary coronary stenting were compared with those of patients who received abciximab in the prehospital phase. Characteristics of the group treated in the ER did not differ significantly from those of patients treated before arrival at the hospital, except for prevalence of diabetes (22 versus 5%, p<0.05) and administration of analgesic to control chest pain (22 versus 65%, p<0.05). Nor did the median time between onset of pain and abciximab administration differ significantly different (120 versus 160 min, NS). In contrast, the median delay between the beginning of abciximab administration and insertion of the cardiac catheter was significantly shorter in the ER group (35 versus 55 min, p<0.05). There were no significant differences between groups in TIMI flow grade before or after revascularization, specific revascularization performed, or outcome. Our study provides some evidence that early administration of abciximab in the ER is safe, feasible, and justified by the delay required for coronary revascularization.