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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

View larger version (13K): [in a new window]   Figure 1 Major outcomes and bleeding complications in patients undergoing early PCI (n = 323, black bars) compared with patients who did not undergo early PCI (n = 162, white bars). ReMI denotes reinfarction; revasc denotes revascularization. *p < 0.05.

View larger version (16K): [in a new window]   Figure 2 The freedom from the composite of death, reinfarction, or urgent revascularization for severe ischemia at 30 days is shown for patients who did (top line) and did not (bottom line) undergo early PCI.

View larger version (23K): [in a new window]   Figure 3 Proportions of patients with TIMI flow grade (bars, left to right) 0, 1, 2, or 3, before and after early PCI.

View larger version (17K): [in a new window]   Figure 4 Hypothetical proportions of patients with TIMI flow grade 3 over time for standard (full-dose) thrombolysis (17,23–25), primary or direct PTCA (23,24), combined therapy with abciximab and reduced-dose thrombolysis (6,9), and facilitated PCI (as defined in this study). Compared with standard thrombolysis, which achieves TIMI grade 3 flow rates of 50% at 60 min and 60% at 90 min, primary angioplasty takes longer to perform, reducing the early benefit, but achieves greater TIMI grade 3 flow rates by 90 min. Combination pharmacological therapy can achieve higher early and late TIMI grade 3 flow as shown in the SPEED trial. The addition of facilitated PCI to combination therapy improves the later TIMI grade 3 flow rate without sacrificing the early benefit of the pharmacological approach.