In-Ambulance Abciximab Administration in STEMI Patients Prior to Primary PCI is Associated with Smaller Infarct Size, Improved LV Function and Lower Incidence of Heart Failure: Results from the Leiden MISSION! Acute Myocardial Infarction Treatment Optimization Program

被引:26
作者
Hassan, Ayman K. M. [1 ,2 ]
Liem, Su San [1 ]
van der Kley, Frank [1 ]
Bergheanu, Sandrin C. [1 ]
Wolterbeek, Ron [3 ]
Bosch, Jan [4 ]
Bootsma, Marianne [1 ]
Zeppenfeld, Katja [1 ]
van der Laarse, Arnoud [1 ]
Atsma, Douwe E. [1 ]
Jukerna, J. Wouter [1 ]
Schalij, Martin J. [1 ]
机构
[1] Leiden Univ, Med Ctr, Dept Cardiol, NL-2300 RC Leiden, Netherlands
[2] Assiut Univ, Dept Cardiol, Assiut, Egypt
[3] Leiden Univ, Med Ctr, Dept Med Stat, NL-2300 RC Leiden, Netherlands
[4] Reg Ambulance Serv Hollands Midden, Leiden, Netherlands
关键词
ST segment elevation myocardial infarction; percutaneous coronary intervention; IIb/IIIa antagonist; reperfusion; PERCUTANEOUS CORONARY INTERVENTION; ST-SEGMENT ELEVATION; PRIMARY ANGIOPLASTY; THROMBOLYTIC THERAPY; EUROPEAN-SOCIETY; REPERFUSION; REDEFINITION; METAANALYSIS; MULTICENTER; INHIBITORS;
D O I
10.1002/ccd.21980
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Our aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short, and long term outcomes. Background: Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains indistinct. Methods: Within a fixed protocol for PPCI, December 2006 was the cut-off point for this prospective study. A total of 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (in-hospital group), and 89 patients received abciximab bolus in the ambulance (in-ambulance group). Results: The two groups were comparable for baseline and angiographic characteristics. The in-ambulance group received abciximab within the golden period (median 63 min). The infarct related artery (IRA) patency at onset of the PCI was four times higher in the in-ambulance group compared to in-hospital group (odds ratio = 4.9,95% Cl 2.4-10.1). Enzymatic infarct size was smaller in the in-ambulance group (cumulative 48-h CK release 8011 vs. 11267 U/L, P = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI measured by myocardial scintigraphy (59% vs. 54%, P = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs. 11%, P = 0.04). Conclusion: Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up. (C) 2009 Wiley-Liss, Inc.
引用
收藏
页码:335 / 343
页数:9
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