Outcome of urgent and elective percutaneous coronary interventions after pharmacologic reperfusion with tenecteplase combined with unfractionated heparin, enoxaparin, or abciximab.

Abstract

OBJECTIVES:

The aim of this study was to evaluate percutaneous coronary intervention (PCI) in the Assessment of the Safety and Efficacy of New Thrombolytic Regimens (ASSENT-3) trial.

BACKGROUND:

In the ASSENT-3 trial, co-therapy with abciximab (ABC) or enoxaparin (ENOX) reduced ischemic complications after ST-elevation acute myocardial infarction treated with tenecteplase when compared with unfractionated heparin (UFH). The effect of these new co-therapies on the results of PCI is unknown.

METHODS:

Clinical outcomes in patients who received co-therapy with ABC, ENOX, or UFH and subsequently underwent an elective (n = 1,064) or urgent (n = 716) PCI in the ASSENT-3 trial were compared.

RESULTS:

No significant differences in clinical end points were observed in patients who underwent an elective PCI. A non-significant trend toward fewer in-hospital myocardial re-infarctions was seen with ABC and ENOX when compared with UFH (0.5% vs. 0.6% vs. 1.5%, respectively). The incidence of bleeding complications was similar in the three treatment arms. Significantly fewer ABC- and ENOX-treated patients needed urgent PCI compared with UFH (9.1% vs. 11.9% vs. 14.3%; p < 0.0001), but outcomes in these patients were in general less favorable (30-day mortality: 8.2% vs. 5.4% vs. 4.5%; 1-year mortality: 11.0% vs. 8.5% vs. 5.6%; in-hospital re-infarction: 3.9% vs. 2.5% vs. 2.7%; major bleeding complications: 8.8% vs. 7.0% vs. 3.4%). In pairwise comparisons with UFH, the higher one-year mortality and major bleeding rates after ABC were statistically significant (p = 0.045 and p = 0.012, respectively).

CONCLUSIONS:

Clinical outcomes after elective PCI were similar with the three antithrombotic co-therapies studied in ASSENT-3. Although fewer patients needed urgent PCI with ABC and ENOX, clinical outcomes were less favorable in this selected population, especially with ABC.

• Authors: Christophe L Dubois, Ann Belmans, Christopher B Granger, Paul W Armstrong, Lars Wallentin, Paolo M Fioretti, José L López-Sendón, Freek W Verheugt, Jürgen Meyer, Frans Van de Werf, ASSENT-3 Investigators
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 42 Issue 7 Pg. 1178-85 (Oct 01 2003) ISSN: 0735-1097 [Print] United States
• PMID: 14522476 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Antibodies, Monoclonal
• Anticoagulants
• Enoxaparin
• Fibrinolytic Agents
• Immunoglobulin Fab Fragments
• Platelet Glycoprotein GPIIb-IIIa Complex
• Heparin
• Tissue Plasminogen Activator
• Tenecteplase
• Abciximab

Topics

• Abciximab
• Alberta
• Angioplasty, Balloon, Coronary
• Antibodies, Monoclonal (administration & dosage)
• Anticoagulants (administration & dosage)
• Belgium
• Drug Administration Schedule
• Drug Therapy, Combination
• Elective Surgical Procedures
• Emergency Treatment
• Enoxaparin (administration & dosage)
• Female
• Fibrinolytic Agents (administration & dosage)
• Germany
• Heparin (administration & dosage)
• Humans
• Immunoglobulin Fab Fragments (administration & dosage)
• Italy
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Netherlands
• North Carolina
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Recurrence
• Spain
• Survival Analysis
• Sweden
• Tenecteplase
• Tissue Plasminogen Activator (administration & dosage)
• Treatment Outcome