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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
Author(s) -
Hassan Ayman K. M.,
Liem Su San,
van der Kley Frank,
Bergheanu Sandrin C.,
Wolterbeek Ron,
Bosch Jan,
Bootsma Marianne,
Zeppenfeld Katja,
van der Laarse Arnoud,
Atsma Douwe E.,
Jukema J. Wouter,
Schalij Martin J.
Publication year - 2009
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21980
Subject(s) - medicine , abciximab , myocardial infarction , ejection fraction , conventional pci , cardiology , percutaneous coronary intervention , heart failure , anesthesia
Abstract 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% CI 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. © 2009 Wiley‐Liss, Inc.