Abciximab Therapy Research Articles

Effect of Abciximab Therapy in Patients Undergoing Coronary Angioplasty for Acute ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock.

The effect of abciximab on survival in patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) undergoing primary percutaneous coronary intervention (PCI) is not clear. METHODS AND RESULTS: We evaluated outcome in 410 consecutive patients with STEMI and CS who underwent PCI treated without (n=123) or with (n=287) abciximab. The endpoint was survival at 1-year follow-up. The predictors of death at 1 year were also investigated. The groups with and without abciximab had similar survival at 1-year follow-up. Propensity score-adjusted Cox proportional hazards model identified age (adjusted hazard ratio [HR], 1.02; 95% confidence interval [95% CI]: 1.01-1.03, P=0.001), oro-tracheal intubation (HR, 1.49; 95% CI: 1.12-1.96, P=0.05), post-PCI TIMI flow grade 0-1 (HR, 2.08; 95% CI: 1.52-2.83, P=0.0001) but not abciximab use (HR, 1.08; 95% CI: 0.70-1.60, P=0.60) as independent predictors of death at 1-year follow-up. Cox adjusted 1-year survival rates were 42.8% and 51.6%, (P=0.56) in patients treated without vs. with abciximab, respectively. Patients with STEMI complicated by CS undergoing PCI treated with or without abciximab have similar 1-year survival rates; age, final TIMI 0-1 and oro-tracheal intubation are predictors of death.

Complications of intracoronary abciximab bolus-only versus standard protocol during percutaneous coronary intervention in acute coronary syndrome

BackgroundAbciximab reduces major adverse cardiac events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Standard protocol is intravenous abciximab bolus during PCI plus abciximab infusion for 12–18 h post pPCI. Intracoronary (IC) abciximab bolus administration results in high local drug concentrations and hence it should have higher antiplatelet effect. In this study, we assess the short-term efficacy and safety of IC compared to IV bolus of abciximab in ACS patients during pPCI. MethodsWe compared the clinical outcomes between the IC (n = 56) and standard protocol (n = 170) group of patients. Primary endpoints included bleeding/vascular/ischemic complications and MACE. ResultsThe two groups were similar with respect to baseline characteristics. IC abciximab bolus only reduced bleeding complications, with no moderate bleed versus 7.2% in standard protocol group (p value 0.04). Ischemic/vascular complications had statistically insignificant difference between the two groups. ConclusionWe found no significant difference between IC abciximab bolus only and standard abciximab therapy in terms of ischemic/vascular complications and MACE. But there was higher risk of moderate bleed in standard therapy group. The IC bolus route of abciximab may be superior to the intravenous route. Prospective randomized trials are warranted to validate these findings.

ST-resolution and microvascular obstruction and infarct size after primary angioplasty: SMART-MRI substudy

Purpose: Optimal myocardial reperfusion in ST-elevation myocardial infarction (STEMI) is associated with better outcome. ST-segment elevation resolution quantifies extent of reperfusion, however it has not been extensively correlated with microvascolar obstruction (MVO) and infarct size (IZ) measured by cardiac magnetic resonance imaging (MRI). Based on the SMART-MRI sub-study, we sought to analyze in STEMI patients the relationship between ST-segment resolution and MVO and IS. Method and results: Eighty STEMI patients (≤6 hours from symptom onset) reperfused by primary angioplasty with routine abciximab therapy were randomly allocated (1:1) to a rheolytic thrombectomy (RT) or manual thrombus aspiration (MTA). MRI was performed within 10±6 days in 37 patients (19 RT, 18 MTA). IS and MVO were measured 15 min after gadolinium injection with late enhancement sequences and were analyzed quantitatively (as percentage of the left ventricular mass –gr/LV mass-) at a core laboratory blinded to randomization. Baseline clinical characteristics were similar between the RT and MTA groups, as well as baseline TIMI thrombus grade (4.47±0.84 vs 4.67±0.76, p=0.453) and rate of initial TIMI flow grade 0-1 (79% vs 83%, P=0.758). After thrombectomy in RT compared with MTA group the thrombus grade decreased to 1.11±1.04 vs 2.17±1.29 (P=0.04), and after infarct artery stenting TIMI 3 flow was 100% vs 89% (P=0.204), and ST-elevation resolution at 30 min and at 60 minutes were: 1±0.8 mm vs. 1.35±0.8 mm, and 0.75±0.67 mm vs. 1.1±0.92 mm (P=0.192 for both), respectively. RT compared with MTA group did not reduced significantly myocardial IS [12.2% (6.4-22.1) vs 19.0% (7-28.5), P=0.224] as well as the extent of MVO [0.0% (0.0-0.17) vs 0.6% (0.0-1.4), P=0.117], but a trend towards a lower incidence of MVO was observed (16% vs 44%, P=0.056). In the entire population, ST-resolution at 30 min showed a strong correlation with both MVO (P=0.024) and IZ (P=0.023), whether at 60 min a strong correlation remains with MVO (P=0.030), but not with IZ (P=0.079). Conclusions: ST-resolution determined at 30 min after primary angioplasty for STEMI is strongly associated with MVO and IZ assessed by cardiac MRI, supporting its use as an early and simple marker of better myocardial reperfusion.

Delayed Immune-Mediated Thrombocytopenia After Re-exposure to Abciximab Therapy

Abciximab is a potent antiplatelet agent that is increasingly being used to prevent ischemic complications of percutaneous coronary revascularization. Thrombocytopenia, including acute profound thrombocytopenia, has been reported to occur with this agent, but usually within 1 to 2 days of exposure. We report the case of a woman aged 68 years who presented with profound delayed thrombocytopenia 9 days after a second exposure to abciximab. She was treated successfully with intravenous immunoglobulin with complete resolution of the thrombocytopenia and no subsequent recurrences.

Abciximab or eptifibatide in percutaneous coronary intervention: in-hospital outcomes and costs and six-month results

Inhibition of platelet aggregation with glycoprotein (GP) IIb-IIIa receptor blockers has been shown to reduce ischemic complications in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI) in multiple placebo-controlled, randomized clinical trials. The effect of pharmacologic and cost differences between abciximab and eptifibatide, the only GP IIb-IIIa inhibitors indicated for PCI, on clinical outcomes and total hospital costs for patients undergoing PCI remain to be defined. To determine the rate of clinical events and costs associated with the use of abciximab vs eptifibatide at our centers, we retrospectively reviewed data for the cohort of 188 consecutive patients who underwent PCI and were treated with either abciximab (n = 85) or eptifibatide (n = 103) in the period between January 1998 and June 1999. The choice of a GP IIb-IIIa inhibitor was based on the preference of the interventional cardiologist. In-hospital events evaluated included death, major bleeding, minor bleeding, and hematoma. Additionally, the duration of hospital stay and total in-hospital costs were also assessed. Clinical events at 6 months included combined incidence of death, acute myocardial infarction (MI), or unstable angina (UA), as well as the incidence of hospital readmissions. In-hospital complications were generally more common with abciximab (death: 4.7% vs 0% with eptifibatide; major bleeding: 7.1% vs 4.8%, respectively; minor bleeding: 9.4% vs 5.7%, respectively; hematoma: 21.2% vs 21.4%, respectively), although none of these differences reached statistical significance. However, abciximab therapy was associated with a significantly longer mean duration of hospitalization (4.17 ± 0.48 days vs 2.85 ± 0.26 days with eptifibatide; P = 0.017) and a significantly higher mean total in-hospital costs ($31,396 ± 2,111 vs $25, 135 ± 815; P = 0.007). At six-month follow-up, the combined incidence of death, acute MI, or UA was also significantly higher in the abciximab group (32.9% vs 15.5%; P = 0.01). Additionally, hospital readmissions related to acute coronary syndromes at 6 months occurred significantly more often in the abciximab group (36.7% vs 16.5% with eptifibatide; P = 0.014). Our retrospective analysis of 188 patients undergoing PCI indicates that the use of eptifibatide instead of abciximab is associated with significantly lower in-hospital costs, significantly shorter duration of index hospitalization, and significantly reduced rates of ischemic complications and cardiovascular readmissions at 6-month follow-up. These differences were seen despite the fact that the baseline characteristics of patients in the two groups were generally similar. Therefore, eptifibatide provides a clinically effective and economically more attractive alternative to abciximab.

Predictive value of ischemic mitral regurgitation during the acute phase of ST elevation myocardial infarction treated with primary coronary intervention for left ventricular remodeling in long-term follow-up

Reperfusion therapy, mainly primary percutaneous coronary intervention (PCI), has improved survival and lowered complication rate in patients with ST elevation myocardial infarction (STEMI). Nevertheless, some patients develop left ventricular remodeling (LVR) during long-term follow-up. To assess the incidence of ischemic mitral regurgitation (MR) in the acute phase of STEMI treated with primary PCI. To assess prognostic value of MR during acute STEMI for prediction of LVR during long-term follow-up. This is a prospective, single-center study in 83 patients with the first STEMI. Inclusion criteria were as follows: time from symptom onset to PCI less than 12 h and successful restoration of blood flow (thrombolysis in myocardial infarction 3) in the infarct-related coronary artery. Transthoracic echocardiography was performed at discharge and 6 months after the MI. At hospital discharge, ischemic MR was found in 35 (42%) patients. At 6 months follow-up, LVR was present in 21 (25%) patients. Univariate analysis revealed that remodeling could be predicted by age, weight, treatment with abciximab, left ventricular ejection fraction (LVEF), leaflets coaptation, coaptation height, tenting area, presence of MR, degree of MR. The best multivariate logistic regression model for remodeling prediction at 6 months was combination of ischemic MR degree (odds ratio (OR)=14.5; 95% confidence interval (CI): 3.89-54.0, P<0.00005), abciximab therapy (OR=0.09; 95% CI: 0.01-0.84, P<0.03) and LVEF (OR=0.89; 95% CI: 0.81-0.99, P<0.03). Ischemic MR in STEMI is frequent, even despite effective primary PCI. The regurgitation grade and lower LVEF assessed at hospital discharge and lack of abciximab administration could predict development of LVR at 6 months.

TCT-459: Safety of Immediate Reversal of Anticoagulation by Protamine to Reduce Bleeding Complications after Infarct Artery Stenting for Acute Myocardial Infarction and Adjunctive Abciximab Therapy

TCT-459: Safety of Immediate Reversal of Anticoagulation by Protamine to Reduce Bleeding Complications after Infarct Artery Stenting for Acute Myocardial Infarction and Adjunctive Abciximab Therapy

Safety of immediate reversal of anticoagulation by protamine to reduce bleeding complications after infarct artery stenting for acute myocardial infarction and adjunctive abciximab therapy

Infarct artery stenting with adjunctive abciximab therapy is widely used treatment for patients with acute myocardial infarction (AMI). However, bleeding complications have been associated with a worse clinical outcome. Randomized trials in elective patients have shown that postprocedural protamine administration is safe and associated with a significant reduction in bleeding complications. The aim of the current study was to evaluate in STEMI patients undergoing primary percutaneous coronary intervention (PCI) with abciximab and stenting whether immediate reversal of anticoagulation by protamine is safe and associated with a reduction in the occurrence of bleeding complications. From January 2004 to June 2005, 254 patients with STEMI had immediate reversal of anticoagulation by protamine administration after infarct artery stenting and received abciximab therapy without heparin infusion (Group 1). These patients were compared with a control group of 265 patients (June 2002–December 2003) treated with the standard heparin therapy: bolus in order to achieve an activated coagulation time of 250–300 s during PCI plus 12-h infusion (7 UI/kg/h; Group 2). We excluded patients undergoing IABP implantation. The two groups were similar in all baseline characteristics. There were no differences in in-hospital mortality, reinfarction, urgent target vessel revascularization, stroke or acute or subacute stent thrombosis, while Group 1 patients showed a lower incidence of major bleeding complications (ACUITY scale: 1.1 vs. 4.0%, P = 0.035) and a shorter length of hospital stay (3.5 ± 1.7 vs. 4.0 ± 1.6 days, P = 0.002) as compared with heparin treated patients. Among patients undergoing primary stenting with abciximab administration, immediate post-PCI reversal anticoagulation by protamine without associated heparin infusion is safe and associated with a significant reduction in major bleeding complications.

Impact of abciximab on mortality and reinfarction in patients with acute ST‐segment elevation myocardial infarction treated with primary stenting

To combine data from all randomized trials of abciximab versus placebo or open-label control in patients with STEMI treated with primary stenting to assess the short-term and long-term mortality, reinfarction, and bleeding complications. Clinical trials of adjunctive abciximab therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary stenting have produced conflicting results. Formal searches of electronic databases (Medline, Cochrane) from January 1990 to April 2009 were performed. Five trials randomizing 2,937 patients (1,475 in the abciximab group, 1,462 in the placebo group) were included in the analysis. When compared with placebo, abciximab was not associated with a significant reduction in the odds of 30-day (OR 0.71, 95% CI: 0.45-1.14, P = 0.16) or long-term (OR 0.85, 95% CI: 0.48-1.50, P = 0.57) mortality. Similarly, the rate of reinfarction was not statistically different at 30 days (OR 0.59, 95% CI: 0.30-1.17, P = 0.13) or at long-term follow-up (OR 0.67; 95% CI: 0.39-1.16, P = 0.16). However, when trials with upstream use of thienopyridines were excluded, abciximab was associated with a significant reduction in the composite of death or reinfarction at 30 days (OR 0.45; 95% CI: 0.26-0.77, P = 0.004) but not at long-term follow-up (OR 0.59; 95% CI: 0.27-1.28, P = 0.18). Routine use of abciximab in patients with STEMI treated with primary stenting may reduce short-term rates of death or reinfarction in patients not administered preprocedural thienopyridine therapy, but does not appear to be beneficial in those who receive preprocedural thienopyridines.

Left Ventricular Function After ST-Elevation Myocardial Infarction in Patients Treated With Primary Percutaneous Coronary Intervention and Abciximab or Tirofiban (from the Facilitated Angioplasty with Tirofiban or Abciximab [FATA] Trial)

Abciximab therapy during primary percutaneous coronary intervention (PCI) has shown to ameliorate left ventricular (LV) function recovery in patients with ST elevated myocardial infarction. High-dose bolus tirofiban has similar effect on platelet inhibition. Whether this is associated with comparable efficacy on LV function recovery remains unclear. We sought to evaluate the impact on LV function of high-dose bolus tirofiban or abciximab in patients undergoing primary PCI with the predictors of favorable (> or = 50%) LV ejection fraction (EF) and LV function recovery at 30 days. We studied 314 patients (abciximab n = 154; tirofiban n = 160) undergoing primary PCI in the randomized Facilitated Angioplasty with Tirofiban or Abciximab (FATA) Trial. LVEF was assessed within 48 hours and at 30 days after primary PCI. In patients with systolic dysfunction at baseline, LV function recovery was defined by either increase of LVEF > or = 10% compared with baseline or LVEF > or = 50%. Similar LVEF was observed in the 2 groups postprocedure (abciximab 49.7 +/- 10.1% vs tirofiban 49.3 +/- 10.1%, p = 0.9) and at 30 days (abciximab 53.1 +/- 9.8% vs tirofiban 52.5 +/- 10.2%, p = 0.6). Independent predictors of 30-day LVEF > or = 50% were preprocedure Thrombolysis In Myocardial Infarction flow class >0 (odds ratio = 2.4, 95% confidence interval 1.32 to 4.34), anterior location (odds ratio = 0.25, 95% confidence interval 0.15 to 0.42), and age (odds ratio = 0.97, 95% confidence interval 0.95 to 0.99). Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 was the only predictor of LV function recovery (odds ratio = 6.73, 95% confidence interval 2.69 to 16.88). In conclusion, this study showed no difference in LV function recovery in patients undergoing primary PCI treated either with abciximab or high-dose bolus tirofiban. Preprocedure Thrombolysis In Myocardial Infarction flow grade >0 seems to be the most important predictor of favorable LVEF and LV function recovery at 30 days.

Abciximab (ReoPro)-Induced Thrombocytopenia Diagnosed Through Measurement of Heparin-Dependent Antibody

Abciximab (ReoPro) is an extremely potent inhibitor of the glycoprotein IIb/IIIa receptor. Its main application is in the maintenance of coronary flow after suboptimal coronary intervention. Complications associated with this drug include bleeding and severe thrombocytopenia. We report a case of severe thrombocytopenia secondary to abciximab therapy for percutaneous coronary intervention in a 65-year-old woman suffering from an acute myocardial infarction. Her platelet count dropped to 1,000/mm 3 7 hours after abciximab administration and improved with transfusion of 12 units of platelet concentrate the following day. The patient was diagnosed through measurement of heparin-dependent antibodies and readministration of heparin. (Korean Circ J 2009;39:75-78)

Prehospital versus periprocedural abciximab in ST -elevation myocardial infarction treated by percutaneous coronary intervention

To investigate the potential benefit of an earliest possible out-of-hospital start of abciximab (ReoPro) therapy in ST-elevation myocardial infarction (STEMI; Lilly, Bad Homburg, Germany) and planned primary percutaneous intervention compared with periprocedural abciximab treatment on reperfusion and clinical outcome. Randomization of one hundred and one patients with STEMI to prehospital or periprocedural abciximab treatment. Evaluation of thrombolysis in myocardial infarction (TIMI) flow, ST-segment resolution, myocardial blush grade, and maximal creatine kinase release before and after as well as clinical follow-up until 6 months after the index event. Prehospital abciximab (group 1) was initiated a median of 101 min (37-165 min) earlier compared with periprocedural treatment (group 2). Initial TIMI 3 flow (24 vs. 15%, P=NS), ST-segment resolution before percutaneous coronary intervention (PCI) (<30%: 33 vs. 46%, P=NS; >70%: 38 vs. 33%, P=NS), post-PCI myocardial blush grade 2 and 3 (72 vs. 75%, P=NS), maximal cardiac enzyme release (creatinine kinase MB median 77 U/l; range 33-137 vs. 74 U/l; range 39-143 U/l, P=NS), and 6 months follow-up (recurrent myocardial infarction or repeat coronary intervention, and PCI, need for coronary bypass surgery) did not differ significantly between both treatment groups. Prehospital intravenous administration of abciximab, although safe and feasible in a trained surrounding, does not add angiographic or clinical benefit to patients with STEMI.

Pre-procedural C-reactive protein levels and clinical outcomes after percutaneous coronary interventions with and without abciximab: pooled analysis of four ISAR trials

Objective: To assess the prognostic value of the baseline C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) after pre-treatment with 600 mg of clopidogrel and whether there...

GP IIb/IIIa inhibitors during primary percutaneous coronary intervention for STEMI: New trial and registry data

Primary percutaneous coronary intervention (PCI) with adjunctive glycoprotein (GP) IIb/IIIa receptor inhibitor therapy administered in the cardiac catheterization laboratory is the optimal reperfusion strategy for patients with ST-elevation myocardial infarction. Most available data regarding these agents are from trials comparing abciximab to placebo alone. Noninferiority trials comparing small-molecule GP IIb/IIIa receptor inhibitors, such as tirofiban and eptifibatide with abciximab, have used markers for myocardial reperfusion as primary end points but are underpowered to detect significant differences in hard clinical outcomes. Such a trial would need to enroll a very large number of patients and thus make it practically impossible to perform. Registry data reveal that most patients undergoing primary PCI are treated with small-molecule GP IIb/IIIa receptor inhibitors in clinical practice, and no observed difference is observed in safety and efficacy when compared with patients treated with abciximab therapy.

Single center experience with provisional abciximab therapy in complex lower limb interventions

Abciximab, a glycoprotein IIb/IIIa antagonist has been shown to improve patency and clinical outcome in patients undergoing endovascular recanalization of femoro-popliteal occlusions. However, data on abciximab therapy in complex peripheral catheter interventions of lower limbs are quite limited. The objective of this retrospective study was to evaluate the clinical and hemodynamic outcomes of patients treated with provisional abciximab during complex peripheral catheter interventions. Analysis of a consecutive series of 44 patients with provisional abciximab therapy in complex peripheral catheter interventions with imminent risk of early rethrombosis defined as revascularization of arterial occlusions associated with one or more of the following additional circumstances named as time-consuming intervention > 3 hours, compromised contrast flow not solved by stenting, distal embolization not solved by mechanical thromboembolectomy, and peri-interventional notice of thrombus evolution despite adequate heparin adjustment of lower limbs. Adjunctive abciximab therapy was started in accordance to percutaneous coronary bailout situations. The decision to add abciximab was based on the decision of the operator and went along with the judgement that there is a rising risk of reocclusion due to the progressive complexity of an individual intervention. A bolus of 0.25 mg per kilogram of body weight, followed by a maintenance infusion of 0.125 microg/kg/min (up to a maximum dosage of 10 microg/min) for 12 hours was administered. Clinical and hemodynamic outcome was prospectively assessed at discharge, three and six months after the index procedure. The occluded artery of 44 limbs was in the iliac (2%), in the femoro-popliteal (73%) or below the knee segment (25%). Overall, occlusion length was 11.5 +/- 6.5 cm. Technical success rate was 95%. Mean ABI increased from 0.5 +/- 0.16 to 0.88 +/- 0.19 (p < 0.001) with immediate hemodynamic improvement of 91%. Overall, sustained clinical improvement was 84% and 66% at three and six months follow-up, with best results in iliac (100%), followed by below the knee (73%) and by femoro-popliteal segment (63%) at six months, respectively. Overall, secondary clinical improvement was 86% at six months. Minor and major bleeding complications were 16% and 9%, respectively. Abciximab should be noticed as medical adjunct in the interventional armamentarium to prevent imminent rethrombosis in complex peripheral catheter interventions.

Effect of Abciximab on Clinical and Angiographic Restenosis in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

The ISAR-REACT 2 trial was designed to assess the effect of abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after a 600-mg loading dose of clopidogrel. The aim of the present study was to investigate the impact of abciximab on clinical and angiographic restenosis after coronary stenting in patients with acute coronary syndromes. The angiographic substudy included 1,544 patients from the ISAR-REACT 2 trial randomly assigned to abciximab (771 patients) or placebo (773 patients). All patients were scheduled for routine angiographic follow-up at 6 to 8 months after intervention. The primary end point was incidence of angiographic in-segment binary restenosis. The secondary end point was 1-year incidence of target-lesion revascularization. Binary restenosis was observed in 21.9% of patients in the abciximab group and 24.5% of patients in the placebo group (p=0.29). Percentages of in-stent (29+/-22% vs 33+/-24%; p=0.02) and in-segment (35+/-20% vs 38+/-21%; p=0.04) diameter stenoses were significantly lower in the abciximab group than the placebo group. There was a strong trend toward lower 1-year incidence of target-lesion revascularization in patients treated with abciximab than in patients treated with placebo (13.6% vs 16.8%; p=0.08). In conclusion, in patients with non-ST-segment elevation acute coronary syndromes undergoing early percutaneous coronary intervention with stenting after a 600-mg loading dose of clopidogrel, abciximab therapy may have a slight positive impact on the prevention of restenosis.

Comparison of Coronary Flow Reserve and Fractional Flow Reserve in Patients With Versus Without Diabetes Mellitus and Having Elective Percutaneous Coronary Intervention and Abciximab Therapy (from the PREDICT Trial)

Patients with diabetes mellitus (DM) have poor long-term outcome after percutaneous coronary intervention (PCI) partly because of microvascular disease and distal embolization. Microvascular obstruction can be assessed by measuring coronary flow reserve (CFR). The Prediction of CK-MB RElease During Successful Stenting Correlating with Indicators of Microvascular ObstruCTion (PREDICT) trial compared the CFR in patients with versus without DM during PCI. Patients undergoing elective PCI were prospectively enrolled according to diabetic (n = 36) and nondiabetic (n = 36) status. All patients received drug-eluting stent with abciximab and were followed for 30-day major adverse cardiac events. CFR and FFR (fractional flow reserve) before and after stenting were measured before and after intracoronary adenosine bolus. Procedural success, MB enzyme of creatine-kinase (CK-MB), troponin I, and high-sensitive C-reactive protein elevation, vascular complications, and major adverse cardiac events were not different. FFR before stenting was 0.77 +/- 0.03 in patients with DM versus 0.76 +/- 0.02 in patients without DM (p = 0.69). FFR after stenting was 0.97 +/- 0.03 and 0.99 +/- 0.01 (p = 0.26), respectively. CFR before stenting was 1.36 +/- 0.31 in patients with DM versus 1.49 +/- 0.25 in patients without DM (p = 0.064). However, CFR after stenting was significantly lower in patients with versus without DM (1.89 +/- 0.30 versus 2.44 +/- 0.67, p <0.001, respectively). CFR after stenting only moderately correlated with CK-MB and high-sensitive C-reactive protein after PCI but did not correlate with 30-day major adverse cardiac events. In conclusion, patients with DM have significantly lower CFR after stenting despite equivalent FFR and myonecrosis compared with patients without DM, indicating greater microvascular obstruction after PCI despite abciximab.

Determinants of final infarct size and incidence of aborted infarction in patients treated with primary coronary intervention and adjunctive abciximab therapy

Assess the determinants of final infarct size in patients successfully treated with primary percutaneous coronary intervention (PCI) and abciximab therapy and check whether infarct abortion may occur. In 208 patients we examined the parameters that predict final infarct size and the incidence of aborted infarction, defined by completely normal perfusion and regional wall motion plus >50% left ventricular ejection fraction (LVEF) in gated single-photon emission computed tomography (SPECT) acquired at one month. In linear regression analysis, sex (p<0.0001), high cholesterol (p<0.05), Killip class (p<0.0001), symptom-to-reperfusion time (p<0.001), admission ST segment elevation (p<0.0001), infarct related artery (p<0.05), and pre-procedural TIMI flow (p<0.002) were significant univariate predictors of final infarct size. In multiple linear regression analysis, symptom-to-reperfusion time (p<0.001), Killip class (p<0.0001), ST segment elevation (p<0.003), and sex (p<0.03) remained significant predictors, model R(2)=0.53. Aborted infarction was registered in 32 patients, more frequently female (59% versus 21%, p<0.00001), older (p<0.02), with larger prevalence of TIMI grade 3 (p<0.05) and lower ST segment elevation at admission (p<0.05). Sex, reperfusion delay, and initial infarct severity as indicated by Killip class and/or ST segment elevation appear the determinants of final infarct size in patients treated with primary PCI. The presence of aborted infarction seems related to the same factors and to preserved TIMI 3 flow.

Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke

Arterial reocclusion and distal embolization are known complications of ischemic stroke intervention, impacting treatment strategies and device design. We sought to determine their rates of occurrence and effects on long-term outcomes during endovascular treatment of patients with acute ischemic stroke. Retrospective analysis of data from 4 prospective acute stroke protocols was performed. Patients underwent the standard technique for parent vessel angiography followed by pharmacologic thrombolysis and/or sonographic thrombolysis and/or mechanical thrombus disruption. Certain patients also received systemic heparin or abciximab therapy. Demographic, clinical, and angiographic variables were assessed at onset, 24 hours, 1 week, and 1-3 months after the event. "Distal embolization" was defined qualitatively as appearance of an occlusion on a downstream vessel. "Arterial reocclusion" was defined as subsequent reocclusion of the target vessel after initial recanalization had been achieved. Arterial reocclusion occurred in 18% of these patients, whereas distal embolization occurred in 16% of the 91 patients treated in these protocols. Arterial reocclusion, but not distal embolization, was associated with a lower likelihood of favorable outcome at 1-3 months (P = .05; odds ratio, 3.9; 95% confidence interval, 0.01-0.98) after adjusting for age, initial National Institutes of Health Stroke Scale scores, sex, time to treatment, initial angiographic grade, symptomatic intracranial hemorrhage, and final recanalization. Arterial reocclusion and distal embolization occur in 16%-18% of patients with stroke undergoing endovascular intervention. Only arterial reocclusion is associated with poor long-term outcome. Prospective studies are needed to identify risk factors for their occurrence and possible preventive therapies.

Abstract 1998: Short- and Long-Term Effects of Abciximab in Patients Undergoing Primary Stenting for Acute Myocardial Infarction: Meta-Analysis of Randomized Trials

Background: Both short- and long-term benefits of abciximab therapy in primary angioplasty for acute myocardial infarction (AMI) have been reported. However, primary stenting is the preferred treatment of AMI and conflicting data exists on the effect of abciximab therapy on outcomes following primary stent treatment of AMI. We therefore performed a meta-analysis of all randomized trials of abciximab in primary stenting for AMI for which there was short-term (30-day) and long-term (≥ 1 year) follow-up. Methods: We searched the MEDLINE and Cochrane databases using the following key words: stent, acute myocardial infarction, abciximab and randomized trial. Four studies (ISAR-2, ADMIRAL, CADILLAC and ACE) were included in this analysis. The incidence of the individual end points of death, reinfarction and target vessel revascularization (TVR) at 30 days and at long-term follow-up was extracted. Follow-up data was available at 1 year for ACE and CADILLAC, at 3 years for ADMIRAL and 5 years for ISAR-2. A random effects model was used to calculate the combined odds ratio (OR) of reinfarction, TVR and mortality associated with the use of abciximab. Results: The 4 trials enrolled 2137 patients of whom 1074 were randomized to abciximab and 1063 to placebo. Long-term follow up was available for 2107 patients, 1064 in the abciximab group and 1043 in the control group. At 30 days, abciximab resulted in a significant reduction in the odds of TVR (OR 0.45, 95% CI, 0.27–0.75, P=0.003) and a non-significant reduction in the odds of reinfarction (OR 0.43, 95% CI, 0.18–1.0, P=0.06) but no reduction in 30-day mortality (OR 0.78, 95% CI, 0.47–1.2, P=0.34). During long-term follow up, abciximab treatment resulted in a non-significant reduction in the risk of TVR (OR 0.77, 95% CI 0.58–1.0, P=0.06) but no reduction in reinfarction (OR 0.58, 95% CI, 0.3–1.1, P=0.12) or mortality (OR 0.90, 95% CI, 0.48–1.6, P=0.74). Conclusions: Abciximab resulted in a significant reduction in TVR at 30 days that diminished over time. We were unable to demonstrate a significant reduction in reinfarction or mortality at 30 days or at 1–5 years. These results suggest the need for an appropriately powered clinical trial to define the role of abciximab during primary stenting for AMI.