Document Detail

Prehospital abciximab in ST-segment elevation myocardial infarction: results of the randomized, double-blind MISTRAL study.
MedLine Citation:
PMID:  22319064     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The value of prehospital initiation of glycoprotein IIb/IIIa inhibitors remains a controversial issue. We sought to investigate whether in-ambulance initiation of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) improves ST-segment elevation resolution (STR) after primary percutaneous coronary intervention (PCI).
METHODS AND RESULTS: MISTRAL (Myocardial Infarction with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in Alsace) is a prospective, randomized, double-blind study. Two hundred and fifty-six patients with acute STEMI were allocated to receive abciximab either in the ambulance (ambulance group, n=127) or in the catheterization laboratory (hospital group, n=129). The primary end point was complete (>70%) STR after PCI. Complete STR was not significantly different between the 2 groups (before PCI, 21.6% versus 15.5%, P=0.28; after PCI, 70.3% versus 65.8%, P=0.49). Thrombolysis In Myocardial Infarction (TIMI) 2 to 3 flow rates before PCI tended to be higher in the ambulance group (46.8% versus 35%, P=0.08) but not after PCI (70.3% versus 65.8%, P=0.49). Slow flow tended to be lower (5.6% versus 13.4%, P=0.07), and distal embolization occurred significantly less often in the ambulance group (8.1% versus 21.1%, P=0.008). One- and 6-month major adverse cardiac event rates were low and similar in both groups.
CONCLUSIONS: Early ambulance administration of abciximab in STEMI did not improve either STR or TIMI flow rate after PCI. However, it tended to improve TIMI flow pre-PCI and decreased distal embolization during procedure. Larger studies are needed to confirm these results.
Patrick Ohlmann; Philippe Reydel; Laurent Jacquemin; Frédéric Adnet; Olivier Wolf; Jean-Claude Bartier; Anne Weiss; Frédéric Lapostolle; Cédric Gaultier; Emmanuel Salengro; Hakim Benamer; Philippe Guyon; Bernard Chevalier; Simon Catan; Patrick Ecollan; Tahar Chouihed; Michael Angioi; Michel Zupan; François Bronner; Pierre Bareiss; Gabriel Steg; Gilles Montalescot; Jean-Pierre Monassier; Olivier Morel
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-02-07
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  5     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-16     Completed Date:  2012-06-08     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-76, S1     Citation Subset:  IM    
Pôle d'Activité Médico-Chirurgicale Cardiovasculaire and SAMU 67, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France.
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MeSH Terms
Angioplasty, Balloon, Coronary*
Antibodies, Monoclonal / administration & dosage*,  adverse effects
Anticoagulants / administration & dosage*,  adverse effects
Double-Blind Method
Emergency Medical Services*
Immunoglobulin Fab Fragments / administration & dosage*,  adverse effects
Middle Aged
Myocardial Infarction / drug therapy*,  physiopathology,  surgery
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Prospective Studies
Treatment Outcome
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Immunoglobulin Fab Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; X85G7936GV/abciximab
Comment In:
Nat Rev Cardiol. 2012 Apr;9(4):186   [PMID:  22371110 ]

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