CLINICAL STUDY
Facilitation of early percutaneous coronary intervention after reteplase with or without abciximab in acute myocardial infarction
Results from the SPEED (GUSTO-4 Pilot) trial
Howard C. Herrmann, MD*,
David J. Moliterno, MD ,
E. Magnus Ohman, MD ,
Amanda L. Stebbins, MS,
Christopher Bode, MD ,
Amadeo Betriu, MD||,
Florian Forycki, MD¶,
Jerry S. Miklin, MD#,
William B. Bachinsky, MD**,
A. Michael Lincoff, MD,
Robert M. Califf, MD and
Eric J. Topol, MD
* Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Cleveland Clinic Foundation, Cleveland, Ohio, USA
Duke Clinical Research Institute, Durham, North Carolina, USA
Universiteit Heidelberg, Heidelberg, Germany
|| Hospital Clinic I, Barcelona, Spain
¶ Krankenhaus Neukoelln, Berlin, Germany
# Lutheran Medical Center, Wheat Ridge, Colorado, USA
** Harrisburg Hospital, Harrisburg, Pennsylvania, USA
Manuscript received January 13, 2000;
revised manuscript received June 6, 2000,
accepted June 21, 2000.
Reprint requests and correspondence: Dr. Howard C. Herrmann, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, Pennsylvania 19104
OBJECTIVES
We examined the utility of early percutaneous coronary intervention (PCI) in a trial that encouraged its use after thrombolysis and glycoprotein IIb/IIIa inhibition for acute myocardial infarction (MI).
BACKGROUND
Early PCI has shown no benefit when performed early after thrombolysis alone.
METHODS
We studied 323 patients (61%) who underwent PCI with planned initial angiography, at a median 63 min after reperfusion therapy began. A blinded core laboratory reviewed cineangiograms. Ischemic events, bleeding, angiographic results, and clinical outcomes were compared between early PCI and no-PCI patients (n = 162), between patients with Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 before PCI versus flow grade 2 or 3, and among three treatment regimens.
RESULTS
Early PCI patients showed a procedural success (<50% residual stenosis and TIMI flow grade 3) rate of 88% and a 30-day composite incidence of death, reinfarction, or urgent revascularization of 5.6%. These patients had fewer ischemic events and bleeding complications (15%) than did patients not undergoing early PCI (30%, p = 0.001). Early PCI was used more often in patients with initial TIMI flow grade 0 or 1 versus flow grade 2 or 3 (83% vs. 60%, p < 0.0001). Patients receiving abciximab with reduced-dose reteplase (5 U double bolus) showed an 86% incidence of TIMI grade 3 flow at  90 min and a trend toward improved outcomes.
CONCLUSIONS
In this analysis, early PCI facilitated by a combination of abciximab and reduced-dose reteplase was safe and effective. This approach has several advantages for acute MI patients, which should be confirmed in a dedicated, randomized trial.
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Abbreviations and Acronyms
| | CTFC | = corrected TIMI frame count | | GUSTO-I | = Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries | | GUSTO-III, –4 | = Global Use of Strategies To Open Occluded coronary arteries | | MI | = myocardial infarction | | PCI | = percutaneous coronary intervention | | SPEED | = Strategies for Patency Enhancement in the Emergency Department | | TIMI | = Thrombolysis In Myocardial Infarction |
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