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Synergistic effect of thrombus aspiration and abciximab in primary percutaneous coronary intervention.

AbstractBACKGROUND:
Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use.
METHODS AND RESULTS:
A total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting (P < 0.001 vs. group 1 for both), presented higher rate of end-procedural TIMI flow grade 3 (P < 0.001 vs. group 1 for both), and lower rate of no-reflow (P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end-procedural TIMI flow grade 3 (P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log-rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28-0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95-0.98, P < 0.001) were significantly associated with lower MACE rate.
CONCLUSIONS:
The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1-year clinical outcome.
AuthorsStylianos A Pyxaras, Fabio Mangiacapra, Katia Verhamme, Luigi Di Serafino, Frederic De Vroey, Gabor Toth, Andrea Perkan, Alessandro Salvi, Jozef Bartunek, Bernard De Bruyne, William Wijns, Gianfranco Sinagra, Emanuele Barbato
JournalCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 82 Issue 4 Pg. 604-11 (Oct 01 2013) ISSN: 1522-726X [Electronic] United States
PMID23359568 (Publication Type: Comparative Study, Journal Article)
CopyrightCopyright © 2013 Wiley Periodicals, Inc.
Chemical References
  • Antibodies, Monoclonal
  • Fibrinolytic Agents
  • Immunoglobulin Fab Fragments
  • Abciximab
Topics
  • Abciximab
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal (adverse effects, therapeutic use)
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Coronary Thrombosis (diagnosis, mortality, therapy)
  • Female
  • Fibrinolytic Agents (adverse effects, therapeutic use)
  • Hemorrhage (chemically induced)
  • Humans
  • Immunoglobulin Fab Fragments (adverse effects, therapeutic use)
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction (diagnosis, mortality, therapy)
  • Percutaneous Coronary Intervention (adverse effects, mortality)
  • Proportional Hazards Models
  • Recurrence
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Suction
  • Thrombectomy (adverse effects, methods, mortality)
  • Time Factors
  • Treatment Outcome

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