Abstract 15952: Mortality Reduction with Administration of Abciximab During Primary Percutaneous Coronary Intervention is Confined to ST-Segment Elevation Myocardial Infarction Patients with Complex Lesions
Background: The optimal timing of administration of the glycoprotein IIb/IIIa inhibitor abciximab (up-stream or in-cath-lab) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is not well established. Data suggest that patients with high-risk profiles benefit from abciximab the most. Complex lesion on coronary angiography (CAG) implies a high-risk profile. In this paper we aim to investigate whether lesion type (complex/simple) predicts the effect of abciximab in STEMI patients undergoing pPCI.
Methods: From our singlecenter PCI-registry we identified 2,935 STEMI patients treated with pPCI between 2003 and 2008. Baseline data were collected prospectively. Mortality, target vessel revascularization (TVR), myocardial infarction (MI), and the combination of these were defined as endpoints. The population was subsequently stratified according to lesion type on CAG (complex/simple) and the use of abciximab. Follow-up was 1 year.
Results: Forty-seven percent of the patients had complex lesion on CAG. Among those, abciximab treatment was associated with a reduced 1-year mortality in both the univariate (from 12.7% to 7.8%, p=0.006) and the adjusted analysis (HR 0.62, CI 0.42-0.91, p=0.015). However, in simple lesions, in which abciximab treatment was used as routine treatment for some operators or as bail-out, an increased mortality was seen in the treatment arm. Effect of abciximab on TVR or MI was neutral. Regarding the combined endpoint, abciximab treatment conferred a risk reduction in patients with complex lesions, and a risk increase in patients with simple lesions.
Conclusion: Benefit of abciximab in STEMI patients undergoing pPCI was confined to those with complex lesions on CAG. Consequently, early abciximab treatment without knowledge of the lesion type may not be recommended.
- © 2012 by American Heart Association, Inc.