Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Thiele, Holger; Schindler, Kathrin; Friedenberger, Josef; Eitel, Ingo; Fürnau, Georg; Grebe, Eigk; Erbs, Sandra; Linke, Axel; Möbius‐Winkler, Sven; Kivelitz, Dietmar; Schuler, Gerhard

doi:10.1161/circulationaha.107.747642

Cited by 270 publications

(147 citation statements)

References 45 publications

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“…40 An abbreviated infusion of GPIs (<12 hours) may be beneficial in the ACS setting. Intracoronary GPIs might also maximize efficacy, 41 but these approaches would need to be prospectively tested in ACS patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Winchester

Brearley

Wen

et al. 2011

Clinical Cardiology

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Background: Early studies of glycoprotein IIb/IIIa inhibitors (GPIs) demonstrated benefit during percutaneous coronary intervention for acute coronary syndromes (ACS). Since their introduction, the magnitude of benefit of GPIs has become unclear. Hypothesis: We hypothesized that adding a GPI to unfractionated heparin in ACS patients treated with stents and thienopyridines is beneficial. Methods: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases for randomized clinical trials that studied the use of GPIs during ACS. We required that patients be randomly assigned to unfractionated heparin plus a GPI versus unfractionated heparin plus placebo (or control). Additional inclusion criteria included the use of coronary stents and periprocedural thienopyridines. Outcomes were assessed at 30 days. Random effects DerSimonian-Laird summary risk ratios (RR) and 95% confidence intervals (CIs) were constructed. Results: Sixteen studies with 7611 patients were included. Myocardial infarction was 3.1% with GPI versus 4.4% with control (RR = 0.74; 95% CI, 0.59-0.94, P = 0.014); revascularization, 1.7% versus 2.7% (RR = 0.64; 95% CI, 0.46-0.89, P = 0.008); major bleeding, 2.5% versus 2.1% (RR = 1.21; 95% CI, 0.89-1.63, P = 0.22); minor bleeding, 5.5% versus 4.1% (RR = 1.37; 95% CI, 1.06-1.78, P = 0.016); and mortality, 2.2% versus 2.9% (RR = 0.79; 95% CI, 0.59-1.06, P = 0.12), respectively. Conclusions: Among ACS patients treated with stents and thienopyridines, GPIs were associated with reduced myocardial infarction and revascularization. Minor, but not major bleeding was increased with GPIs. Mortality was similar between the groups.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Winchester

Brearley

Wen

et al. 2011

Clinical Cardiology

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“…7 The application of platelet glycoprotein IIb/IIIa receptor antagonists (in combination with antiplatelet agents, anticoagulants and anti-inflammatory drugs) can decrease infarct size, reduce the degree of microvascular damage and improve myocardial perfusion. 8 Research has shown that, with a severe thrombus burden, application of thrombus aspiration and tirofiban during an emergency PCI procedure can improve blood no/ slow reflow and lead to improved outcomes. 9 There remains, however, a substantial thrombus load in patients with acute MI who have exceeded the emergency PCI time window (12 h).…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention

et al. 2013

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Objective: To compare the efficacy and safety of combined treatment with thrombus aspiration and intracoronary tirofiban in patients with acute myocardial infarction (MI), with elective percutaneous coronary intervention (PCI). Methods: Patients undergoing elective PCI during recovery from acute MI were randomized into two groups; the intervention group received thrombus aspiration and intracoronary tirofiban; the control group received conventional PCI. Baseline clinical characteristics, postoperative coronary blood flow (thrombolysis in myocardial infarction [TIMI] grade), TIMI myocardial perfusion (TMP) grade, no/slow reflow rate and cardiac function (measured by echocardiography 1 month postoperatively) were evaluated. Major adverse cardiac event rate and bleeding complications during surgery (and at 1 month and 1 year postoperatively) were also evaluated. Results: A total of 80 patients were included. Postoperatively, the number of patients with TIMI flow grade 3 and the mean TMP grade were both significantly higher, and the no/slow reflow rate was significantly lower, in the intervention group versus the control group. Echocardiography indicated that cardiac function was significantly improved in the intervention group compared with the control group. There were no major complications in either study group. Conclusion: Thrombus aspiration combined with intracoronary tirofiban during recovery from acute MI was effective and relatively well tolerated.

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“…This could probably be explained by myocardial stunning which took some time to resolve. Further, in an magnetic resonance imaging (MRI) study, Thiele and colleagues found no significant improvement in LVEF and volumes 1 to 4 days after an acute STEMI [6]. Thus, our first echocardiogram performed within 3 days after a STEMI appears representative of LV function post-MI.…”

Section: Discussionmentioning

confidence: 64%

“…It may improve clinical outcomes in patients with STEMI undergoing primary PCI. This alternative approach has been investigated in several studies to further characterize the clinical benefits of this mode of drug delivery, but the results are still controversial [6][7][8][9][10]. Ischemic injury after MI affects not only systolic but also diastolic function of the left ventricle (LV).…”

Section: Introductionmentioning

confidence: 99%

Intravenous versus intracoronary bolus of glycoprotein IIb/IIIa inhibitor administration during primary percutaneous coronary intervention on long-term left ventricular systolic and diastolic function

Pellicori

Torromeo²,

Barillà³

et al. 2013

Cardiol J

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Background: In primary percutaneous coronary intervention (PCI), glycoprotein (GP) IIb/IIIa inhibitors are often given in order to attain and maintain better myocardial perfusion. We tested the hypothesis that intracoronary (IC) bolus of GP IIb/IIIa inhibitors might produce a greater improvement in left ventricular (LV) systolic and diastolic function than an intravenous (IV) bolus. Methods and results: Seventy seven patients undergoing primary PCI for their first ST elevation myocardial infarction (STEMI) were randomly assigned to either an IC or IV bolus of GP IIb/IIIa inhibitor, followed by IV infusion. Compared with the echocardiographic findings within 3 days after PCI, LV ejection fraction was higher at 1 year, with no significant differences between the IV and IC groups (IV: 44% vs. 49%, p = 0.001; IC: 43% vs. 48%, p < 0.001 (Cardiol J 2013; 20, 3: 310-317)

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Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract: Background-Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI

Cited by 270 publications

References 45 publications

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Clinical evaluation of thrombus aspiration combined with tirofiban in patients with acute myocardial infarction with elective percutaneous coronary intervention

Intravenous versus intracoronary bolus of glycoprotein IIb/IIIa inhibitor administration during primary percutaneous coronary intervention on long-term left ventricular systolic and diastolic function

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