Use and efficacy of abciximab in an unselected population with acute myocardial infarction treated with primary angioplasty: data from AMI-Florence registry.

Abstract

AIMS:

We sought to evaluate the determinants and the potential benefit of abciximab use in unselected patients with acute myocardial infarction treated with primary angioplasty.

METHODS AND RESULTS:

Based on the AMI-Florence registry, we analyzed 461 consecutive acute myocardial infarction patients treated with primary angioplasty, 280 (61%) of whom received abciximab. For each patient, a propensity score indicating the likelihood of abciximab treatment was calculated. Compared to those not treated, patients treated with abciximab were at lower risk. At multivariate analysis, the direct admission to a hospital with angioplasty facilities significantly increased the probability of receiving abciximab (OR 1.99, 95% CI 1.30-3.03, p=.001), while older age (OR 0.97, 95% CI 0.95-0.98, p<.0001), non-anterior location (OR 0.58, 95% CI 0.38-0.88, p=.011) and Killip class >1 (OR 0.53, 95% CI 0.32-0.87, p=.013), were negative predictors of abciximab use. Primary angioplasty had a higher success rate in patients treated with abciximab (99.3% versus 96.5%, p=.03). In-hospital and 1-year mortality were significantly lower in patients treated with abciximab (2.5% versus 13.3%, p<.0001, and 7% versus 21%, p<.0001, respectively). At multivariate analysis patients treated with abciximab had a significantly lower risk of in-hospital mortality (OR 0.35, 95% CI 0.14-0.93, p=.035), and a marginally lower risk of death at 1-year follow-up (HR 0.58, 95% CI 0.32-1.03, p=.065). These results did not change when the propensity score was included into the analyses.

CONCLUSIONS:

In the real practice, abciximab is more frequently used in patients at lower risk, particularly when directly admitted to a hospital with angioplasty facilities. Abciximab use is associated with a significant reduction in early mortality. A trend toward a reduced mortality is maintained also at 1 year.

• Authors: G M Santoro, N Carrabba, A Barchielli, D Balzi, N Marchionni, M Filice, S Valente, M Granelli, I Berni, E Buiatti, AMI-Florence Working Group
• Journal: Atherosclerosis (Atherosclerosis) Vol. 195 Issue 1 Pg. 116-21 (Nov 2007) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 16997308 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Anticoagulants
• Immunoglobulin Fab Fragments
• Abciximab

Topics

• Abciximab
• Acute Disease
• Aged
• Angioplasty (methods)
• Antibodies, Monoclonal (therapeutic use)
• Anticoagulants (therapeutic use)
• Female
• Humans
• Immunoglobulin Fab Fragments (therapeutic use)
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (drug therapy)
• Odds Ratio
• Registries
• Risk
• Treatment Outcome