In‐ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: Results from the Leiden MISSION! acute myocardial infarction treatment optimization program

Abstract

Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up.

Evolution and Emergence of Therapeutic Monoclonal Antibodies

“…Evolution of the mAb field has facilitated the transition from murine and chimeric mAbs to humanized and, most recently, fully human mAbs in an effort to reduce the risk of immunogenicity. Fully human mAbs directed against interleukin-1β and PCSK9 are under active investigation in by guest on May 11, 2018 http://circ.ahajournals.org/ Downloaded from the cardiovascular field. Given the considerable burden of cardiovascular disease in industrialized countries, results from ongoing studies will add to current evidence for the use of mAbs in cardiology applications.…”

“…by guest on May 11, 2018 http://circ.ahajournals.org/ Generation of fully human therapeutic mAbs was made possible by the development of phage-display platforms and, more recently, by transgenic mouse platforms. 12,13 Adalimumab, the first fully human anti-tumor necrosis factor-α mAb to reach the US marketplace, was developed with the use of phage display.…”

“…47 Recent prospective clinical trial data have also emerged to suggest additional benefits for intracoronary bolus administration or in-ambulance use of abciximab. 48,49 Data from a meta-analysis suggest that abciximab and small-molecule and peptide-based glycoprotein IIb/IIIa inhibitors (tirofiban and eptifibatide, respectively) provide similar benefits in primary percutaneous coronary intervention in terms of postprocedural flow grade, ST-segment resolution, mortality, and early reinfarction. The development and use of mAbs for treating hypercholesterolemia is based on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) in cholesterol metabolism as a mediator of hepatic low-density lipoprotein receptor degradation.…”

Management of acute coronary syndrome: achievements and goals still to pursue. Novel developments in diagnosis and treatment

“…In NSTEMI patients, upstream administration is discouraged because the risk of bleeding outweighs the risk of thrombotic complications [51]. However, in STEMI patients, early (prehospital) administration seems to be beneficial, in particular following timely presentation (<3 h) and ⁄ or in high-risk patients [52][53][54][55].…”

Translating from the rivers of Babylon to the coronary bloodstream

“…Very early administration of αIIbβ3 antagonists has been shown to increase coronary artery blood flow (84) and decrease both infarct size and mortality in high-risk groups (85,86). Speed of administration is of the essence, since the benefit decreases rapidly if the αIIbβ3 antagonist is administered more than one hour after the onset of symptoms (81).…”