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Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine.

AbstractBACKGROUND:
Primary angioplasty is the best treatment of acute myocardial infarction but fails to achieve adequate myocardial reperfusion in 25% to 30% of patients, despite TIMI grade 3 flow. Drug treatment aimed at reducing the no-reflow phenomenon may improve myocardial salvage, thus preventing left ventricular remodeling. Our aim was to evaluate the impact of abciximab and adenosine on immediate angiographic results and on 6-month left ventricular remodeling.
METHODS:
Ninety consecutive patients undergoing primary angioplasty with coronary stenting were randomized in a sequential alternating fashion to standard abciximab treatment (ABCX) group, intracoronary adenosine distal to the occlusion (ADO) group, or neither (CTRL) group. All patients underwent a clinical and echocardiographic follow-up at 1 and 6 months. The primary end point was the prevalence of 6-month left ventricular remodeling.
RESULTS:
Baseline clinical, echocardiographic, and angiographic characteristics were similar. Mean final corrected TIMI frame count was 17 +/- 9, 16 +/- 12, and 23 +/- 11 frames in ABCX, ADO, and CTRL patients, respectively (P = .002). Angiographic no-reflow was observed in 7%, 13%, and 17% of ABCX, ADO, and CTRL patients, respectively (P > .20). At 6 months, left ventricular remodeling occurred in 7%, 30%, and 30% of ABCX, ADO, and CTRL patients, respectively (P = .045), with a percent increase in end-diastolic volume of 5% +/- 13%, 15% +/- 15%, and 12% +/- 18% (P = .04).
CONCLUSIONS:
During primary angioplasty, abciximab enhances myocardial reperfusion, translating into a reduced incidence of 6-month left ventricular remodeling. In contrast, adenosine administration improves angiographic results but does not prevent left ventricular remodeling.
AuthorsAnna S Petronio, Marco De Carlo, Nicola Ciabatti, Giovanni Amoroso, Ugo Limbruno, Caterina Palagi, Vitantonio Di Bello, Maria F Romano, Mario Mariani
JournalAmerican heart journal (Am Heart J) Vol. 150 Issue 5 Pg. 1015 (Nov 2005) ISSN: 1097-6744 [Electronic] United States
PMID16290987 (Publication Type: Journal Article, Randomized Controlled Trial)
Chemical References
  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Adenosine
  • abciximab
Topics
  • Adenosine (administration & dosage)
  • Angioplasty, Balloon, Coronary
  • Antibodies, Monoclonal (therapeutic use)
  • Coronary Vessels
  • Female
  • Humans
  • Immunoglobulin Fab Fragments (therapeutic use)
  • Male
  • Middle Aged
  • Ventricular Remodeling

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