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Synergistic effect of thrombus aspiration and abciximab in primary percutaneous coronary intervention
Author(s) -
Pyxaras Stylianos A.,
Mangiacapra Fabio,
Verhamme Katia,
Di Serafino Luigi,
De Vroey Frederic,
Toth Gabor,
Perkan Andrea,
Salvi Alessandro,
Bartunek Jozef,
De Bruyne Bernard,
Wijns William,
Sinagra Gianfranco,
Barbato Emanuele
Publication year - 2013
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.24837
Subject(s) - medicine , abciximab , percutaneous coronary intervention , thrombus , cardiology , percutaneous , coronary thrombosis , myocardial infarction
Background Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use. Methods and Results A total of 644 consecutive ST‐segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting ( P < 0.001 vs. group 1 for both), presented higher rate of end‐procedural TIMI flow grade 3 ( P < 0.001 vs. group 1 for both), and lower rate of no‐reflow ( P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end‐procedural TIMI flow grade 3 ( P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log‐rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28–0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95–0.98, P < 0.001) were significantly associated with lower MACE rate. Conclusions The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1‐year clinical outcome. © 2013 Wiley Periodicals, Inc.