Document Detail


Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trial.
MedLine Citation:
PMID:  11918909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with acute myocardial infarction might benefit from the addition of glycoprotein IIb/IIIa inhibitors to fibrinolytic or mechanical reperfusion strategies. We compared two strategies, stenting and fibrinolysis, both combined with abciximab, in terms of their ability to salvage myocardium in patients with acute myocardial infarction.
METHODS: We enrolled 162 patients with acute myocardial infarction within 12 h of onset of symptoms, assigning 81 stenting plus abciximab and 81 alteplase plus abciximab. Technetium-99m sestamibi scintigraphy was done at admission and after a median of 11 days to calculate initial perfusion defect, final infarct size, and degree of myocardial salvage. The primary endpoint was the salvage index (the ratio of the degree of myocardial salvage to the initial perfusion defect). Major adverse clinical events within 6 months from randomisation were also compared between the two treatments.
FINDINGS: Paired scintigraphic measurements were available for 70 patients in the stent group and 71 in the alteplase group. Stenting was associated with greater myocardial salvage than alteplase (median 13.6% [IQR 5.9-23.9] vs 8.0% [2.5-16.0] of the left ventricle; p=0.007). Salvage index was greater in the stent group than in the alteplase group (median 0.60 [0.37-0.82] vs 0.41 [0.13-0.58]; p=0.001). The 6-month mortality rate was 5% (four deaths) in the stent group and 9% (seven deaths) in the alteplase group (relative risk 0.56 [95% CI 0.17-1.88]; p=0.35).
INTERPRETATION: In patients with acute myocardial infarction, a reperfusion strategy based on stenting with abciximab produced more myocardial salvage than the combination of fibrinolysis plus abciximab. Larger studies are needed to assess whether these effects translate into clinical benefit.
Authors:
Adnan Kastrati; Julinda Mehilli; Josef Dirschinger; Ullrich Schricke; Jodi Neverve; Jürgen Pache; Stefan Martinoff; Franz Josef Neumann; Stephan Nekolla; Rudolf Blasini; Melchior Seyfarth; Markus Schwaiger; Albert Schömig;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  359     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-03-28     Completed Date:  2002-04-09     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  920-5     Citation Subset:  AIM; IM    
Affiliation:
Deutsches Herzzentrum, Technische Universität, Munich, Germany. kastrati@dhm.mhn.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Antibodies, Monoclonal / therapeutic use*
Female
Fibrinolysis*
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Male
Middle Aged
Myocardial Infarction / drug therapy*,  radionuclide imaging,  therapy
Salvage Therapy / methods
Stents*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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