Efficacy of Combination Treatment with Intracoronary Abciximab and Aspiration Thrombectomy on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Stenting.
10.3349/ymj.2014.55.3.606
- Author:
Sung Gyun AHN
1
;
Seung Hwan LEE
;
Ji Hyun LEE
;
Jun Won LEE
;
Young Jin YOUN
;
Min Soo AHN
;
Jang Young KIM
;
Byung Su YOO
;
Junghan YOON
;
Kyung Hoon CHOE
;
Seung Jea TAHK
Author Information
1. Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea. carshlee@yonsei.ac.kr
- Publication Type:Original Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
- Keywords:
Abciximab;
thrombosuction;
myocardial perfusion;
myocardial infarction
- MeSH:
Adolescent;
Adult;
Aged;
Angioplasty, Balloon, Coronary/*methods;
Antibodies, Monoclonal/*therapeutic use;
Female;
Humans;
Immunoglobulin Fab Fragments/*therapeutic use;
Male;
Middle Aged;
Myocardial Infarction/*drug therapy/*surgery;
Thrombectomy/*methods;
Young Adult
- From:Yonsei Medical Journal
2014;55(3):606-616
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. RESULTS: IMR was lower in the combination group than in the IC abciximab group (23.5+/-7.4 U vs. 66.9+/-48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5+/-7.4 U vs. 37.2+/-26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9+/-48.7 U vs. 37.2+/-26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). CONCLUSION: Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).
