Randomized Early Versus Late Abciximab in Acute Myocardial Infarction Treated With Primary Coronary Intervention (RELAx-AMI Trial)

Abstract

In patients with AMI treated with primary PCI, early abciximab administration improves pre-PCI angiographic findings, post-PCI tissue perfusion, and 1-month left ventricular function recovery, possibly by starting early recanalization of the infarct-related artery.

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

“…Early complete ST-segment resolution Ͼ70% was observed in 50% to 59% in the early-administration-treated patients, which is comparable to the intravenous group in our trial but lower than in the intracoronary group. 30,31 Similarly, the angiographic perfusion grade after PCI was similar between the intravenous group and previously published results, whereas the intracoronary group had nonstatistically significant higher perfusion grades. 31 Infarct size as an end point in reperfusion trials has been advocated because of its potential prognostic value.…”

“…30,31 Similarly, the angiographic perfusion grade after PCI was similar between the intravenous group and previously published results, whereas the intracoronary group had nonstatistically significant higher perfusion grades. 31 Infarct size as an end point in reperfusion trials has been advocated because of its potential prognostic value. 34 We used a sensitive and reliable method, which, compared with scintigraphic studies, has the advantage of higher spatial resolution with the ability to detect even small subendocardial infarcts and allows a sample size reduction because of its accuracy.…”

“…Clinical trials have shown that earlier administration results in higher preinterventional TIMI flow with subsequent improved perfusion after PCI. 30,31 However, in a pooled analysis and a recently published trial, there was no effect on mortality or clinical end points. 32,33 Because the door-to-balloon-times were extremely short in a highly experienced tertiary care center in the present trial, earlier abciximab administration requires treatment in the prehospital setting, which poses substantial logistical obstacles.…”

Part 9: Acute Coronary Syndromes

“…This result was supported by many studies which consistently reported better outcomes with upstream or early use of glycoprotein IIb/IIIa inhibitor compared with deferred treatment or other strategies (LOE 1 [452][453][454][455][456][457][458][459][460][461][462][463][464][465][466][467] ; LOE 2 468 -473 ; LOE 3 474 ; LOE 4 [475][476][477][478] ; LOE 5 479 ).…”

Canadian Cardiovascular Society Working Group: Providing a perspective on the 2007 focused update of the American College of Cardiology and American Heart Association 2004 guidelines for the management of ST elevation myocardial infarction

“…Consistent with the Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) trial (47), which tested the concept of full-dose fibrinolysis-facilitated PCI, FINESSE failed to demonstrate an advantage of half-dose fibrinolysis combined with abciximab in conjunction with urgent PCI. Furthermore, despite previous small investigations suggesting a possible benefit of early abciximab administration before PCI, there was no clear benefit for those patients who received early administration of abciximab versus those receiving this agent in the catheterization laboratory at the time of primary PCI (46,(48)(49)(50).…”