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Recent evidence from the Thrombolysis in Myocardial Infarction (TIMI) 14 trial suggests that combining reduced- dose fibrinolytic therapy with the potent platelet inhibition aorded by a glycoprotein (GP) IIb/IIIa receptor antag- onist can help overcome the limitations of fibrinolytic therapy alone. The TIMI 14 investigators found that low- dose alteplase in combination with abciximab significantly increased the incidence of TIMI 3 flow at 60 and 90 min compared with full-dose alteplase. The use of abciximab emerged as one of the three principal determinants of TIMI 3 flow, along with time to treatment and location of the occlusive thrombus. Complete ST-segment resolution, reflecting perfusion at the myocardial tissue level, was a significant predictor of 30-day survival in the TIMI 14 study. Patients treated with abciximab plus reduced-dose fibrinolytic therapy had significantly greater median ST- segment resolution and a significantly higher rate of com- plete ST-segment resolution than patients given fibrinolytic therapy alone. Similar benefits were observed in TIMI 14 patients who underwent early adjunctive percutaneous coronary intervention following combined therapy with abciximab and reduced-dose fibrinolysis. These findings indicate that a strategy coupling abciximab with reduced- dose fibrinolytic therapy not only enhances epicardial flow but also improves myocardial reperfusion following acute myocardial infarction. (Eur Heart J Supplements 2001; 3 (Suppl A): A8-A13)

Epicardial flow and myocardial reperfusion following abciximab and low-dose thrombolytic therapy for acute myocardial infarction