Reversal of slow flow phenomenon during primary stenting by bail-out administration of abciximab

Abstract

BACKGROUND: Slow flow or no reflow phenomenon is increasingly being recognized as a serious problem during coronary angioplasty and stenting. This phenomenon is seen more often during angioplasty in highly thrombogenic milieux, especially in a setting of acute myocardial infarction. The treatment of this complication is often not satisfactory. In this study the authors assessed the efficacy of abciximab, a potent antiplatelet drug, in treating slow flow or no reflow phenomenon during primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). METHODS: Twenty-one instances of persistent slow flow phenomenon were encountered in 131 consecutive patients subjected to primary PTCA for AMI (16%). It was more common in patients presenting with AMI complicated by cardiogenic shock (nine of 21, 43%). Of these 21 cases of slow flow, 10 patients were given injection abciximab during the procedure of primary PTCA as a bail-out measure after encountering the complication of slow flow or no reflow. A pre-discharge coronary angiography was carried out in all patients who survived. RESULTS: In seven of 10 patients in the abciximab group flow had improved to TIMI-3. In contrast, in the non-abciximab group TIMI flow improved in only four of 11 patients. Patients with persistent slow flow had significantly higher mortality at the first 30-day follow-up than patients with TIMI-3 flow (33% versus 1.8%, p<0.001). CONCLUSION: In this small nonrandomized study significant improvement in coronary flow was achieved by using intravenous abciximab after observing slow flow or no reflow phenomenon during primary PTCA. More frequent use of this drug in this milieu might help in preventing the development of this complication. Larger studies are warranted to confirm this life-saving beneficial effect of bail-out administration of abciximab during primary angioplasty.

Glycoprotein IIb/IIIa receptor antagonists in acute myocardial infarction and primary coronary stenting: Not always effective

“…Kaul et al describe, in an observational nonrandomized study, an improvement in coronary ow achieved by using intravenous abciximab after observing no-re ow phenomenon during primary percutaneous transluminal coronary angioplasty. 2 In the case presented here, of a 22-year-old man in whom a fast and effective reperfusion of the infarct-related artery was of the utmost importance, abciximab was not so effective. It did not clear the thrombotic occlusion, nor did it restore ow in the artery after the thrombotic occlusion was recanalized mechanically.…”

Effect of Intravenous Abciximab on Coronary Flow Improvement After Re-vascularization in Primary Coronary Intervention and Short Term Impact

“…Patients with no-reflow after primary PCI who regain normal blood flow in the six-month angiography had a significantly better LV function than those with suboptimal blood flow persisted six months after primary PCI. Long-term prognostic data have been published ( 14 ) and confirmed the persistent poor prognostic effect of no-reflow causing an increase in five-year mortality from 9.5% to 18.2 % ( 15 ).…”

Pharmacological Management of No Reflow During Percutaneous Coronary Intervention

“…It appears that glycoprotein IIb/IIIa blockade maintains patency of recanalised coronary vessel and may prevent formation and embolisation of platelet aggregates into the distal circulation [23]. The use of glycoprotein IIb/IIIa antagonists is indicated in high-risk coronary interventions and primary PCI [24]. Glycoprotein IIb/IIIa antagonists dramatically reduces platelet aggregate size and increases the fibrin accessibility of ex-vivo platelet rich clot in acute STEMI patients.…”