A Randomized Double-Blind Placebo-Controlled Study Comparing Intracoronary Versus Intravenous Abciximab in Patients With ST-Elevation Myocardial Infarction Undergoing Transradial Rescue Percutaneous Coronary Intervention After Failed Thrombolysis

Autor: Jean-Pierre Déry, Olivier Costerousse, Valérie Gaudreault, Gérald Barbeau, Olivier F. Bertrand, Frédéric Maes, Eric Larose, Rodrigo Bagur, Charles Pirlet, Bernard Noël
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Abciximab
Placebo-controlled study
Magnetic Resonance Imaging
Cine
030204 cardiovascular system & hematology
Placebo
Coronary Angiography
03 medical and health sciences
Electrocardiography
0302 clinical medicine
Percutaneous Coronary Intervention
Double-Blind Method
Internal medicine
Catheterization
Peripheral
medicine
Humans
Thrombolytic Therapy
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Treatment Failure
medicine.diagnostic_test
Dose-Response Relationship
Drug
business.industry
Percutaneous coronary intervention
Thrombolysis
Middle Aged
medicine.disease
Injections
Intra-Arterial
Conventional PCI
Injections
Intravenous
Radial Artery
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
medicine.drug
Follow-Up Studies
Zdroj: The American journal of cardiology. 122(1)
ISSN: 1879-1913
Popis: The risk and benefit ratio of glycoprotein IIb/IIIa inhibitors with dual oral antiplatelet therapy after failed thrombolysis and rescue percutaneous coronary intervention (PCI) is unclear. Using a randomized placebo-controlled, double-blind design, we compared intravenous (IV) and intracoronary (IC) abciximab delivery in 74 patients referred for rescue transradial PCI. The primary angiographic end points were the final thrombolysis in myocardial infarction flow and myocardial blush grades. Secondary end points included acute and 6-month outcomes using angiographic parameters, platelet aggregation parameters, cardiac biomarkers, cardiac magnetic resonance measurements (CMR) and clinical end points. After rescue PCI, normal thrombolysis in myocardial infarction 3 flows were obtained in 70% in the IC group, 48% in the IV group, and 71% in the placebo group, respectively (p = 0.056). Final myocardial blush grades 2 and 3 were obtained in 43% and 39% in the IC group, 48% and 26% in the IV group, and 46% and 42% in the placebo group (p = 0.67), respectively. Acutely, peak release of cardiac biomarkers, necrosis size, myocardial perfusion and no-reflow as assessed by CMR, and clinical end points were similar between the groups and did not suggest a benefit for IC or IV abciximab compared with placebo. There was no increase in bleeding or access site-related complications with abciximab compared with placebo. Clinical, angiographic, and CMR outcomes at 6 months remained comparable between the groups. In patients with ST-elevation myocardial infarction presenting with failed thrombolysis undergoing transradial rescue PCI, IC or IV abciximab had no significant clinical impact.
Databáze: OpenAIRE
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