Abciximab Improves Both Epicardial Flow and Myocardial Reperfusion in ST-Elevation Myocardial Infarction

Abstract

MD; for the TIMI 14 InvestigatorsBackground-In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation. Methods and Results-All 346 patients with interpretable baseline and 90-minute ECGs, treated with either tPA alone or abciximab plus reduced-dose tPA (combination therapy), were included. Patients receiving combination therapy (nϭ221) had a 59% rate of complete (Ն70%) ST resolution at 90 minutes versus 37% in those treated with tPA alone (nϭ125) (PϽ0.0001). When the analysis was limited to patients with TIMI 3 flow, patients treated with combination therapy (nϭ151) remained significantly more likely to achieve complete ST resolution than those receiving tPA alone (nϭ80) (69% versus 44%; Pϭ0.0002). Conclusions-Combination

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

“…In addition, the extent of ST-segment resolution was a sensitive parameter to identify the superiority of stenting over thrombolysis as reperfusion strategy in patients with AMI. Previous studies in patients treated with thrombolysis or primary percutaneous coronary intervention for AMI showed that the extent of the early ST-segment resolution correlates with the angiographic flow to the infarct area, 7,8 the enzymatic 9 and scintigraphic final infarct size, 10 the left ventricular function, and clinical outcome. 7,8,11 We also found a good correlation between a greater STsegment resolution and a smaller scintigraphic final infarct size and better survival rate at 6 months.…”

Relationship of admission hematological indexes with myocardial reperfusion abnormalities in acute ST segment elevation myocardial infarction patients treated with primary percutaneous coronary interventions

“…Although the patients were not randomized based on tirofiban administration in our study group, this finding points out potential beneficial effects of tirofiban administration on microvascular reperfusion. It is likely that, by inhibiting platelet activation and aggregation, tirofiban reduces the occurence of platelet microembolization and subsequent microvascular plugging and dysfunction, thus improving myocardial reperfusion (30). Huczek et al (8) showed the association of higher MPV values with angiographic no-reflow and long-term adverse clinical events in acute STEMI patients treated with primary PCI.…”

Fibrinolysis for Acute Myocardial Infarction

“…Although Thrombolysis In Myocardial Infarction (TIMI 3) coronary flow has traditionally been viewed as the most reliable surrogate of successful coronary reperfusion, it is now clear that this is an inadequate measure of myocardial perfusion in many patients (irrespective of how it is achieved). 10,11 The most readily available and clinically useful tool for assessing reperfusion success is the extent of ST-segment resolution from the baseline electrocardiogram; hence, Ͼ50% or 70% ST resolution within the first 60 to 180 minutes after therapy provides excellent insight into the ultimate infarct size, left ventricular function, and survival. 12,13 Major evolution in both the location and timing of fibrinolysis has occurred since the initial intracoronary administration of streptokinase in the cardiac catheterization laboratory over a quarter century ago 14 (Figure 1).…”