Intralesional Abciximab and Thrombus Aspiration in Patients With Large Anterior Myocardial Infarction

Abstract

By achieving high local drug concentrations, intracoronary abciximab may be more effective in reducing platelet thromboemboli than when administered intravenously. 7,8 However,Background-Whether intralesional abciximab administration and thrombus aspiration confer clinical benefits to patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction is controversial. Methods and Results-A total of 452 patients with ST-segment-elevation myocardial infarction caused by proximal or mid left anterior descending artery occlusion undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation were randomized in a 2×2 factorial design to bolus abciximab delivered locally at the infarct lesion site versus no abciximab and to manual thrombus aspiration versus no aspiration. Treatment with intralesional abciximab, thrombus aspiration, or both therapies compared with no active therapy before stent implantation resulted in lower 1-year rates of death (4.5% versus 10.4%; P=0.03), severe heart failure (4.2% versus 10.3%; P=0.02), and stent thrombosis (0.9% versus 3.8%; P=0.046). Between 30 days and 1 year of follow-up, treatment with intralesional abciximab compared with no abciximab was associated with a lower rate of death (1.4% versus 4.9%; P=0.04) and composite major adverse ischemic events (3.3% versus 7.8%; P=0.04), with nonsignificantly different overall 1-year rates of mortality, composite ischemic events, and heart failure-related events. Thrombus aspiration compared with no aspiration was associated with lower rates of new-onset severe heart failure between 30 days and 1 year (0.9% versus 4.5%; P=0.02) and of rehospitalization for heart failure from randomization to 1 year (0.9% versus 5.4%; P=0.0008), with nonsignificantly different rates of mortality. Conclusions-Intralesional abciximab and thrombus aspiration may have long-term benefits in patients with anterior STsegment-elevation myocardial infarction presenting early after symptom onset and undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00976521.(Circ Cardiovasc Interv. 2013;6:527-534.)

Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction

“…17,18 Mortality at 1 year in the thrombusaspiration group (4.9%) was similar to that in the TASTE trial (5.3%) and was not significantly different from that in the PCI-only group of the INFUSE-AMI trial (7.0%). Recently, observational data from 1498 patients with STEMI that was identified in a randomized trial of treatment with drug-eluting stents showed that clinical outcomes with thrombus aspiration were similar to those with stenting alone.…”

Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention?

“…Three trials reported outcomes at both 1 and 12 months. 5,12,14,[38][39][40] The mean time between the onset of symptoms to primary PCI was similar in both groups (4.5±1.5 hours; P=0.86). Five trials defined MACE as the composite of death, reinfarction, stroke, or target vessel revascularization.…”

“…Major adverse cardiac and cerebrovascular events at 1 year were numerically lowest (6.8%) in the group that received intralesional abciximab and thrombectomy, when compared with 8.5% with aspiration thrombectomy alone, 9.3% with intralesional abciximab alone, and 11.2% with neither; however, these differences did not achieve statistical significance (P=0.71). 39 A recent study demonstrated that concomitant use of glycoprotein IIb/IIIa inhibitors may have a synergistic effect with aspiration thrombectomy on 30-day mortality. 42 However, that analysis did not include the totality of data.…”

Clinical Outcomes of Manual Aspiration Thrombectomy in Patients with Acute Myocardial Infarction: An Updated Meta-Analysis

“…We identified 16 prospective randomized trials which enrolled 10,437 controls that underwent conventional PCI and 10,385 patients who underwent PCI with AT with an average follow-up duration of 5.8 months (table 1) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. All patients received aspirin before the procedure and thienopyridines pre- or postprocedure.…”