Facilitated PCI in patients with ST-elevation myocardial infarction

Authors	ELLIS SG SIEGELOVÁ Jarmila TENDERA M DE Belder MA VAN Boven AJ WIDIMSKÝ Petr JANSSENS L ANDERSEN HR BETRIU A SAVONITTO S ADAMUS J PERUGA JZ KOSMIDER M KATZ O NEUNTEUFL T JORGOVA J DOROBANTU M GRINFELD L ARMSTRONG P BRODIE BR HERRMANN HC MONTALESCOT G NEUMANN FJ EFFRON MB BARNATHAN ES TOPOL EJ
Year of publication	2008
Type	Article in Periodical
Magazine / Source	New England Journal of Medicine
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1056/NEJMoa0706816
Field	Other specializations of internal medicine
Description	Background We hypothesized that percutaneous coronary intervention (PCI) preceded by early treatment with abciximab plus half-dose reteplase (combination-facilitated PCI) or with abciximab alone (abciximab-facilitated PCI) would improve outcomes in patients with acute ST-segment elevation myocardial infarction, as compared with abciximab administered immediately before the procedure (primary PCI). Methods In this international, double-blind, placebo-controlled study, we randomly assigned patients with ST-segment elevation myocardial infarction who presented 6 hours or less after the onset of symptoms to receive combination-facilitated PCI, abciximab-facilitated PCI, or primary PCI. All patients received unfractionated heparin or enoxaparin before PCI and a 12-hour infusion of abciximab after PCI. The primary end point was the composite of death from all causes, ventricular fibrillation occurring more than 48 hours after randomization, cardiogenic shock, and congestive heart failure during the first 90 days after randomization. Results A total of 2452 patients were randomly assigned to a treatment group. Significantly more patients had early ST-segment resolution with combination-facilitated PCI (43.9%) than with abciximab-facilitated PCI (33.1%) or primary PCI (31.0%; P = 0.01 and P = 0.003, respectively). The primary end point occurred in 9.8%, 10.5%, and 10.7% of the patients in the combination-facilitated PCI group, abciximab-facilitated PCI group, and primary-PCI group, respectively (P = 0.55); 90-day mortality rates were 5.2%, 5.5%, and 4.5%, respectively (P = 0.49). Conclusions Neither facilitation of PCI with reteplase plus abciximab nor facilitation with abciximab alone significantly improved the clinical outcomes, as compared with abciximab given at the time of PCI, in patients with ST-segment elevation myocardial infarction.