Yonsei Med J.  2014 May;55(3):606-616. 10.3349/ymj.2014.55.3.606.

Efficacy of Combination Treatment with Intracoronary Abciximab and Aspiration Thrombectomy on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Stenting

Affiliations
  • 1Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Korea. carshlee@yonsei.ac.kr
  • 2Department of Cardiology, Ajou University Medical Center, Suwon, Korea. sjtahk@ajou.ac.kr

Abstract

PURPOSE
We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
MATERIALS AND METHODS
We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5.
RESULTS
IMR was lower in the combination group than in the IC abciximab group (23.5+/-7.4 U vs. 66.9+/-48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5+/-7.4 U vs. 37.2+/-26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9+/-48.7 U vs. 37.2+/-26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively).
CONCLUSION
Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).

Keyword

Abciximab; thrombosuction; myocardial perfusion; myocardial infarction

MeSH Terms

Adolescent
Adult
Aged
Angioplasty, Balloon, Coronary/*methods
Antibodies, Monoclonal/*therapeutic use
Female
Humans
Immunoglobulin Fab Fragments/*therapeutic use
Male
Middle Aged
Myocardial Infarction/*drug therapy/*surgery
Thrombectomy/*methods
Young Adult
Antibodies, Monoclonal
Immunoglobulin Fab Fragments

Figure

  • Fig. 1 Diagrammatical representation of the study. STEMI, ST-elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction; CMR, cardiac magnetic resonance imaging; CKD, chronic kidney disease; ECG, electrocardiogram; MI, myocardial infarction.

  • Fig. 2 Index of microcirculatory resistance (IMR) and cardiac magnetic resonance imaging (CMR). (A) IMR is 34.2 U as a consequence of 67 mm Hg, the distal mean coronary pressure multiplied by 0.51 s, the hyperemic mean transit time. (B, left) Early (2 min after contrast injection) gadolinium-enhanced CMR showed a central hypoenhanced area corresponding microvascular obstruction (MVO) in the anteroseptal myocardial infarction (arrowheads). (B, right) Delayed (10 min after contrast injection) contrast-enhanced CMR revealed hyperenhancement indicating an anteroseptal infarction with a central hypoenhanced zone of MVO (arrow).

  • Fig. 3 Comparison of index of microcirculatory resistance (IMR) among the 3 groups. IMR was lower in the combination group than in the intracoronary (IC) abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the aspiration thrombectomy (AT) group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). No difference in IMR was found between the IC abciximab and the AT group (p=0.451).

  • Fig. 4 Comparison of index of microcirculatory resistance (IMR) based on the presence of microvascular obstruction (MVO) and ST-segment resolution, or myocardial blush grade (MBG). IMR was higher in subjects with MVO or MBG 0/1 than those without MVO or with MBG 2/3 (53.4±44.3 U vs. 21.5±5.2 U, p=0.015 for MVO; 75.2±50 vs. 25.3±12.1, p=0.007 for MBG). No difference of IMR was found according to the ST-segment resolution (41.6±33 U vs. 33±32 U, p=0.408).


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