Document Detail


ST-segment resolution 60 minutes after combination treatment of abciximab with reteplase or reteplase alone for acute myocardial infarction (30-day mortality results from the resolution of ST-segment after reperfusion therapy substudy).
MedLine Citation:
PMID:  15464665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The combination of abciximab with thrombolytic therapy when treating acute ST-elevation myocardial infarction has been hypothesized to enhance microvascular perfusion. Resolution of ST-segment elevation after thrombolytic therapy is believed to be a marker of myocardial reperfusion and to predict mortality rate. Among 16,588 patients enrolled in the Fifth Global Use of Strategies to Open Occluded Arteries in Acute Myocardial Infarction trial, 1,764 consecutive patients from selected centers had their study electrocardiograms evaluated by a core laboratory for ST-segment deviation resolution 60 minutes after treatment. Patients were categorized into 4 groups: complete resolution (>70%), partial resolution (<70% to 30%), no resolution (<30%), and worsening ST-segment deviation. Patients treated with reteplase or a combination of reteplase plus abciximab had similar rates of complete resolution (32% vs 34%), partial resolution (29% vs 27%), no resolution (15% vs 16%), and worsening ST-segment elevation (23 vs 23%; p = 0.59). The 30-day mortality rates in these 4 groups were 2.1%, 5.2%, 5.5%, and 8.1% (p <0.001). Even after accounting for baseline variables, incomplete ST-segment resolution (<70%) was associated with an increased risk of death within 30 days (adjusted hazard ratio 2.41, 95% confidence interval 1.25 to 4.63, p <0.008). Thus, ST-segment resolution at 60 minutes was no different in patients treated with full-dose reteplase from those treated with a combination of abciximab and reteplase. Patients with >70% ST-segment resolution within 60 minutes had markedly decreased mortality rates, irrespective of treatment.
Authors:
Fernando A Cura; Marco Roffi; Narcis Pasca; Katherine E Wolski; A Michael Lincoff; Eric J Topol; Michael S Lauer;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  94     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2004-11-08     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  859-63     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
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MeSH Terms
Descriptor/Qualifier:
Aged
Antibodies, Monoclonal / therapeutic use*
Combined Modality Therapy
Double-Blind Method
Drug Therapy, Combination
Electrocardiography*
Female
Fibrinolytic Agents / therapeutic use*
Heart Conduction System / drug effects*,  pathology*
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Male
Middle Aged
Myocardial Infarction / mortality*,  therapy*
Myocardial Reperfusion*
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors,  therapeutic use
Predictive Value of Tests
Recombinant Proteins / therapeutic use*
Survival Analysis
Time Factors
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 133652-38-7/reteplase; EC 3.4.21.68/Tissue Plasminogen Activator; X85G7936GV/abciximab

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


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