Letter by Abdellaoui et al Regarding Article, “Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention”
To the Editor:
We read with interest the article by Thiele et al1 assessing the effect of abciximab delivered via an intracoronary route during primary percutaneous coronary intervention for limiting microvascular obstruction and infarct size on magnetic resonance imaging in ST-elevation myocardial infarction. However, we are concerned by a potential methodological bias, because unfortunately the areas at risk were not assessed. Area at risk could by itself explain up to 50% of infarct-size variability in experimental studies.2 In the clinical setting, the size of the area at risk could be easily assessed either by left ventricular angiography3,4 or by single-photon emission computed tomography imaging,5 and this appears to be a major factor that should be taken into account in the assessment of ischemia in clinical studies. Moreover, questions exist as to the clinical impact of this study; the effects of major predictive factors (such as Killip class) were not tested with a course of abciximab in multiple regression analysis.
Thiele H, Schindler K, Friedenberger J, Eitel I, Fürnau G, Grebe E, Erbs S, Linke A, Möbius-Winkler S, Kivelitz D, Schuler G. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial. Circulation. 2008; 118: 49–72.
Reimer KA, Jennings RB, Cobb FR, Murdock RH, Greenfield JC Jr, Becker LC, Bulkley BH, Hutchins GM, Schwartz RP Jr, Bailey KR. Animal models for protecting ischemic myocardium: results of the NHLBI Cooperative Study: comparison of unconscious and conscious dog models. Circ Res. 1985; 56: 651–665.
Staat P, Rioufol G, Cung T, Piot C, Cottin Y, Aupetit JF, Bonnefoy E, Finet G, André-Fouët X, Ovize M. Postconditioning the human heart. Circulation. 2005; 112: 2143–2148.
Thibault H, Piot C, Staat P, Bontemps L, Sportouch C, Rioufol G, Cung TT, Bonnefoy E, Angoulvant D, Aupetit JF, Finet G, André-Fouët X, Macia JC, Raczka F, Rossi R, Itti R, Kirkorian G, Derumeaux G, Ovize M. Long-term benefit of postconditioning. Circulation. 2008; 117: 1037–1044.
Argaud L, Rioufol G, Lièvre M, Bontemps L, Legalery P, Stumf M, Finet G, Itti R, André-Fouët X, Ovize M. Preconditioning during coronary angioplasty: no influence of collateral perfusion or the size of the area at risk. Eur Heart J. 2004; 25: 2019–2025.