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CLINICAL STUDIES

Abciximab in primary coronary angioplasty for acute myocardial infarction improves short- and medium-term outcomes

^a Division of Cardiology, Hartford Hospital and the University of Connecticut School of Medicine, Hartford, Connecticut, USA

Manuscript received January 28, 1998; revised manuscript received July 24, 1998, accepted August 20, 1998.

Address for correspondence: Rabih R. Azar, MD, Division of Cardiology, Beth-Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215
razar{at}bidmc.harvard.edu

Objectives. The purpose of this study was to compare the outcome of primary percutaneous transluminal coronary angioplasty for acute myocardial infarction (MI) when performed with or without the platelet glycoprotein IIb/IIIa antibody, abciximab.

Background. Abciximab improves the outcome of angioplasty but the effect of abciximab in primary angioplasty has not been investigated.

Methods. Data were collected from a computerized database. Follow-up was by telephone or review of outpatient or hospital readmission records.

Results. A total of 182 consecutive patients were included; 103 received abciximab and 79 did not. The procedural success rate was 95% in the two groups. At 30-day follow-up, the composite event rate of unstable angina, reinfarction, target vessel revascularization and death from all causes was 13.5% in the group of patients who did not receive abciximab, 4% (p < 0.05) in the abciximab group and 2.4% (p < 0.05) in the subgroup of patients (n = 87) who completed the 12-h abciximab infusion. At the end of follow-up (mean 7 ± 4 months), the composite event rate was 32.4%, 17% (p < 0.05) and 13.1% (p < 0.01) in these three categories respectively. Abciximab bolus followed by a 12-h infusion was an independent predictor of event-free survival, in a Cox proportional hazards model (relative risk 0.49; 95% confidence interval 0.24 to 0.99; p < 0.05).

Conclusions. Abciximab given at the time of primary angioplasty may improve the short- and medium-term outcome of patients with acute MI, especially when a 12-h infusion is completed.

Abbreviations and Acronyms   ECG = electrocardiographic   EPIC = Evaluation of c7E3 for the Prevention of Ischemic Complications   GP = glycoprotein   MI = myocardial infarction   TIMI = Thrombolysis in Myocardial Infarction

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