Effects of Abciximab as adjunctive therapy in primary percutaneous coronary intervention patients (results from the DANAMI‐2 trial)

Abstract

Successful reperfusion at the epicardial level is not always accompanied by reperfusion of the microvasculature. Therapies targeted against 'no-flow' are often employed in patients receiving primary percutaneous coronary intervention (pPCI) after acute myocardial infarction. Abciximab as adjunctive to pPCI will improve ST-segment resolution used as a surrogate for optimal microvascular reperfusion, and improve prognosis. In the DANAMI-2 trial 309/790 (39%) patients treated with pPCI received abciximab at physician discretion. SigmaST-segment elevation at baseline, 90 min, 4 h, 12 h, 24 h after pPCI and at discharge was measured and ST-segment resolution grouped as: Complete (> or = 70 %); Partial (> or = 30 to < 70%); No (< 30%). Clinical endpoints were death, re-infarction and disabling stroke. Abciximab prescription varied from 24.4-60.3% in the different hospitals. Patients receiving abciximab had a higher risk profile. ST-segment resolution at 90 min and 24 h was identical in the two groups, but at 4 h and 12 h partial ST-segment resolution was more pronounced in patients receiving abciximab (P = 0.001, P = 0.026). In a multivariate analysis, adjusting for baseline differences abciximab was associated with improved partial ST-segment resolution at 12 h. Patients treated with abciximab had no re-infarction at 30 days (0% versus 2.8%, P = 0.003), but increased disabling stroke rate (2.3% versus 0.4%; P = 0.019) driven by cerebral infarctions, and not intracranial hemorrhage. There were no differences in death rates. In the DANAMI-2 trial with no age limit, the decreased re-infarction rates in patients receiving abciximab was offset by increased disabling stroke rates. Abciximab in conjunction with pPCI is associated with more pronounced partial ST-segment resolution after 4 h to 12 h suggesting improved microvascular reperfusion.