Abciximab combined with half-dose reteplase has beneficial effects on inflammatory myocardial response in patients with myocardial infarction

Abstract

In patients with ST-segment elevation myocardial infarction (STEMI), myocardial reperfusion is associated with an inflammatory response leading to adverse effects on further myocardial damage. Therefore, we investigated the effects of the thrombolytic regimen with half-dose reteplase (r-PA) combined with abciximab on different cytokines involved in the local and systemic inflammatory scenario in STEMI patients. Thirty-eight STEMI patients were enrolled in this study. We investigated the effects of the regimen with half-dose r-PA plus abciximab versus full-dose r-PA on interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), MCP-1 and tumor necrosis factor-alpha (TNF-alpha) up to 48 h after the start of therapy. The full-dose r-PA group had a significant IL-6 increase after 48 h compared with the combination group. Furthermore, the full-dose r-PA group showed a marked increase of IL-10 (up to 3 h after) compared with a 41% IL-10 decrease in the combination group. MCP-1 decreased significantly after 3 h in the combination group compared with patients on r-PA therapy only. The combination group showed a nonsignificant increase in IL-8 within the first 6 h. There were no differences in TNF-alpha levels between the two infarct groups. In vivo, the investigated combined thrombolytic regimen consisting of half-dose r-PA plus abciximab causes less of an IL-6 increase and marked decreases in IL-10 and MCP-1 in STEMI patients compared with the pure r-PA thrombolytic regimen. This observation suggests that besides the known beneficial effects on systemic coagulation and leukocyte-platelet aggregates, this regimen may exert a favorable influence on myocardial tissue damage and thus on cardiac repair following myocardial infarction.