Does early abciximab improve angiographic outcome and left ventricular function in patients with acute MI?

Maarten L Simoons

This article has no abstract so we have provided the first paragraph of the full text.

Inhibition of platelet aggregation by glycoprotein IIb/IIIa receptor blockers reduces periprocedural myocardial damage and improves outcome in patients undergoing PCI, particularly in those presenting with an acute coronary syndrome and elevated markers of myocardial necrosis (i.e. MI).¹ In patients with ST-segment elevation undergoing primary PCI, treatment with the glycoprotein IIb/IIIa receptor blocker abciximab has been shown to significantly reduce mortality at 1 month and at later (6–12 months) follow-up.² As early as 1999, a pilot study suggested that pretreatment with abciximab improved coronary perfusion on diagnostic angiography in patients awaiting primary PCI.³ Subsequent observational studies⁴ and randomized trials^{5, 6, 7} confirmed these observations, and demonstrated that early administration of abciximab or tirofiban improved ST-segment resolution, coronary perfusion before PCI, and clinical outcome, when compared with abciximab or tirofiban treatment in the catheterization laboratory. In a pooled analysis of six studies (602 patients), 30-day mortality was reduced in patients who received abciximab before coronary angiography (i.e. prehospital treatment by ambulance physicians, or in the emergency room) compared with those who were given abciximab during angiography (2.7% vs 4.7% respectively, P = 0.20). The incidence of the combined end point of death, reinfarction, or target renal revascularization was also lower with early than with late abciximab (7.3% vs 9.7%, P = 0.30), although these findings were not statistically significant.⁷

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