Early abciximab administration in acute myocardial infarction treated with primary coronary intervention

BACKGROUND: Glycoprotein IIb/IIIa inhibitors improve myocardial reperfusion and clinical outcomes of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), but optimal timing of administration remains unclear. In this prospective randomized trial, we evaluated the impact of early abciximab administration on angiographic findings, myocardial salvage and left ventricular function. METHODS AND RESULTS: Fifty-five consecutive patients with first AMI, undergoing primary PCI, were randomized to abciximab administration either in the emergency room (early group: 27 patients) or in the catheterization laboratory after coronary angiography (late group: 28 patients). The primary outcome measures were initial Thrombolysis In Myocardial Infraction (TIMI) grade flow, corrected TIMI frame count and myocardial blush grade as well as salvage index and left ventricular function recovery as assessed by serial scintigraphic scans performed at admission, and 7 days and 1 month after PCI. Angiographic analysis showed a significant difference in initial TIMI grade 3 flow, corrected TIMI frame count and myocardial blush grade favouring early group. Moreover, salvage index and left ventricular function recovery were significantly greater in the early group (P=0.007; and P=0.043, respectively). CONCLUSIONS: In patients with AMI, treated with primary PCI, early abciximab administration improves myocardial salvage and left ventricular function recovery probably by starting early recanalization of the infarct-related artery.     

Early administration of abciximab bolus in the emergency department improves angiographic outcome after primary PCI as assessed by TIMI frame count: results of the early ReoPro administration in myocardial infarction (ERAMI) trial.

OBJECTIVES: We assessed the safety and efficacy of early administration of abciximab prior to percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. BACKGROUND: Research suggests that platelet glycoprotein IIb/IIIa receptor inhibitors, e.g. abciximab, may improve myocardial perfusion. In particular, early administration in the emergency department, prior to PCI, may result in more effective reperfusion. METHODS: Eighty AMI patients with planned PCI were randomized in a double-blind fashion to receive a 0.25 mg/kg abciximab bolus either "early" in the emergency department or "late" in the catheterization laboratory after angiographic assessment. In total, 74 patients underwent PCI after diagnostic angiography, all of which then received an abciximab infusion of 0.125 microg/kg/min for 12 hr. RESULTS: Prior to PCI, no significant differences were observed between the two groups regarding the angiographic endpoints or ST-segment resolution. After PCI, thrombolysis in MI (TIMI) frame count (TFC) was significantly improved in patients treated early rather than in those treated late (23 +/- 10 vs. 41 +/- 35; P = 0.02). Consistent trends, also favoring early treatment, were observed for TIMI flow grade 3 (TFG 3), corrected TFC (CTFC), and TIMI myocardial perfusion grade 3 (TMPG 3). Nine deaths (4 early, 5 late) and six significant bleeds (4 early, 2 late) were observed at 30 days after randomization. CONCLUSIONS: Early administration of abciximab is both feasible and safe in patients planned for primary PCI, increasing coronary flow and myocardial reperfusion after PCI, as demonstrated by significantly decreased TFC scores and trends toward improvements in TFG, CTFC, and TMPG.     

Randomized early versus late abciximab in acute myocardial infarction treated with primary coronary intervention (RELAx-AMI Trial).

OBJECTIVES: This prospective randomized trial evaluates the impact of early abciximab administration on angiographic and left ventricular function parameters. BACKGROUND: Glycoprotein IIb/IIIa inhibitors improve myocardial reperfusion in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), but optimal timing of administration remains unclear. METHODS: Two-hundred ten consecutive patients with first AMI undergoing primary PCI were randomized to abciximab administration either in the emergency room (early group: 105 patients) or in the catheterization laboratory, after coronary angiography (late group: 105 patients). Primary end points were initial Thrombolysis In Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), and myocardial blush grade (MBG), as well as left ventricular function recovery as assessed by serial echocardiographic evaluations. RESULTS: Angiographic pre-PCI analysis showed a significantly better initial TIMI flow grade 3 (24% vs. 10%; p = 0.01), cTFC (78 +/- 30 frames vs. 92 +/- 21 frames; p = 0.001), and MBG 2 or 3 (15% vs. 6%; p = 0.02) favoring the early group. Consistently, post-PCI tissue perfusion parameters were significantly improved in the early group, as assessed by 60-min ST-segment reduction > or =70% (50% vs. 35%; p = 0.03) and MBG 2 or 3 (79% vs. 58%; p = 0.001). Left ventricular function recovery at 1 month was significantly greater in the early group (mean gain ejection fraction 8 +/- 7% vs. 6 +/- 7%, p = 0.02; mean gain wall motion score index 0.4 +/- 0.3 vs. 0.3 +/- 0.3, p = 0.03). CONCLUSIONS: In patients with AMI treated with primary PCI, early abciximab administration improves pre-PCI angiographic findings, post-PCI tissue perfusion, and 1-month left ventricular function recovery, possibly by starting early recanalization of the infarct-related artery.     

Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours.

In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI. We compared the outcome of 212 consecutive patients with AMI undergoing either direct or facilitated PCI according to the hour of presentation. Patients arriving off-hours were pretreated with alteplase (20 mg) and abciximab and underwent facilitated PCI. Patients presenting on-hours underwent direct PCI. A basal Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was observed in 1.0% of patients undergoing direct PCI and in 44% of patients undergoing facilitated PCI (P = 0.001). More patients starting PCI with a TIMI 3 flow achieved a postinterventional fast TIMI frame count (72.0% vs. 38.8% direct PCI group vs. 34.9% facilitated PCI group with basal TIMI 0-2; P = 0.001) and a TIMI perfusion grade 3 (66.0% vs. 38.8% direct PCI group vs. 39.7% facilitated PCI group with basal TIMI 0-2; P = 0.004). Preinterventional TIMI flow grade 3 was associated with a higher gain in left ventricular ejection fraction at 1 month (10.9% +/- 6.4% vs. 7.0% +/- 9.6% direct PCI group vs. 6.1% +/- 6.0% facilitated PCI group with basal TIMI 0-2; P = 0.005). No significant difference was observed in major bleedings, although there was a trend toward a higher risk in the facilitated PCI group. Patients in the facilitated PCI group achieving a basal TIMI 3 flow showed improved myocardial reperfusion and better left ventricular function recovery. Bleeding complications associated with combination therapy remained an important concern.     

Increase of myocardial salvage and left ventricular function recovery with intracoronary abciximab downstream of the coronary occlusion in patients with acute myocardial infarction treated with primary coronary intervention.

In this prospective randomized trial on patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI), we hypothesized that abciximab administered intracoronarily, downstream of the coronary occlusion, leads to a greater degree of myocardial salvage and better left ventricular function recovery compared with the usual abciximab administration. Forty-five consecutive patients with first AMI and infarct-related artery TIMI flow 0-1 undergoing primary PCI were enrolled. Twenty-two patients were randomly assigned to the intracoronary treatment and 23 to the usual treatment. The initial perfusion defect, final infarct size, myocardial salvage, salvage index, and left ventricular function recovery were assessed by serial scintigraphic scans performed at admission and 7 days and 1 month after PCI. Angiographic myocardial blush grade, corrected TIMI frame count, and electrocardiographic ST segment elevation reduction were also assessed as markers of myocardial reperfusion. Final infarct size was significantly smaller (P = 0.043) and salvage index significantly higher (P = 0.003) in the intracoronary treatment group as a result of a greater degree of myocardial salvage (P = 0.0001). The increase of left ventricular ejection fraction at 1 month was significantly higher in the intracoronary treatment patients (P = 0.013). The markers of myocardial reperfusion were also significantly better in the intracoronary treatment group. In patients with AMI and occluded infarct-related artery treated with primary PCI, intracoronary abciximab given just before PCI downstream of the occlusion is associated to a greater degree of myocardial salvage than the usual abciximab protocol. This benefit is mainly related to a substantial reduction in final infarct size, which leads to an improvement in left ventricular ejection fraction.     

早期应用替罗非班对急性心肌梗死患者急诊冠状动脉介入治疗术后的影响

目的:观察早期应用替罗非班对急性心肌梗死(AMI)患者急诊PCI术后心肌灌注情况及短期疗效的影响。方法:选择接受急诊PCI的AMI患者113例,随机分为:早期替罗非班组(60例),诊断明确后立即经静脉给予替罗非班负荷剂量10μg/kg继以0.15μg.kg-1.min-1维持泵入48h;常规治疗组(53例),于冠脉造影开始时给予替罗非班,用药方法及剂量同早期替罗非班组。比较PCI术前、术后梗死相关动脉TIMI血流情况,PCI术后TIMI心肌灌注分级(TMPG),ST段回落情况,术后心功能情况,住院期间主要心脏不良事件发生率。结果:早期替罗非班组术前TIMI血流2级比例明显高于常规治疗组(13.3%比1.9%,P=0.037),术后即刻两组TIMI血流分级无显著性差异(P=0.188);术后早期替罗非班组TMPG 3级比例明显高于常规治疗组(88.3%比73.6%,P=0.034),术后2h心电图ST段回落>50%比例早期替罗非班组亦明显高于常规治疗组(78.3%比60.4%,P=0.038),术后7d两组LVEF水平及住院期间主要心脏不良事件发生率的差异无显著性(P>0.05)。结论:早期应用替罗非班可以改善TIMI血流和术后心肌灌注,并不增加住院期间主要心脏不良事件。     

ST段抬高的急性心肌梗死介入治疗后早期ST段下降幅度的临床意义

目的通过分析ST段抬高的急性心肌梗死(STEMI)患者接受急诊介入治疗成功后早期抬高ST段的下降幅度,评价ST段的早期恢复程度与介入术后血流恢复程度对患者心功能预测价值以及与住院期间不良事件发生率的相关性。方法连续120例首次急性ST段抬高急性心肌梗死患者,于发病12H以内接受介入治疗,测量并比较介入治疗前以及治疗后2HST段抬高振幅总和(∑STE)的下降幅度,介入后血流的恢复情况。发病后2～4周行超声心动图检查测定左心室射血分数(LVEF),评价心脏收缩功能。比较∑STE明显下降(下降≥50%,A组)与无明显下降(B组)对心功能的影响,并比较冠状动脉TIMI血流与心功能恢复的关系,以及∑STE恢复与冠状动脉血流的关系。结果两组患者情况:A组81例(67.5%),B组39例(32.5%)。A组患者的LVEF明显高于B组[(58.6±7.1)%比(50.5±7.1)%,P<0.05]。KILLIP分级Ⅲ、Ⅳ级发生率A组明显低于B组(1.2%比12.8%,P<0.05)。住院期间心脏不良事件(再发急性心肌梗死、心原性休克、急性肺水肿、发病30D内死亡)的患者发生率A组显著低于B组(0%比7.7%,P<0.01)。成功介入治疗后冠状动脉造影血流达到TIMI3级者108例,占90%,其中仍有31例(28.7%)患者ST段未能很快下降50%;12例血流TIMI2级者,仅4例ST段很快下降50%,8例(66.7%)的患者ST段未能很快下降50%。发生心脏事件的3例患者均落在血流未达到TIMI3级且∑STE无明显下降的8例中。结论急性ST段抬高心肌梗死患者急诊介入治疗后早期抬高ST段下降幅度能作为心脏收缩功能和住院期间心脏不良事件发生情况的间接预测指标。∑ST段的下降比TIMI血流能更准确地反映心肌再灌注情况,是血管再通后心肌再灌注的更好指标。TIMI血流结合体表心电图的∑STE改变能更好地预测急性心肌梗死患者介入术后的临床预后。     

半剂量替罗非班联合PCI对早期肾功能不全急性心肌梗死患者的疗效及安全性

目的：观察半剂量替罗非班联合经皮冠脉介入治疗（PCI）对合并早期肾功能不全急性心肌梗死（AMI）患者的疗效及安全性。方法：选择合并早期肾功能不全的AMI患者55例作为肾功能不全组,56例肾功能正常的AMI患者作为AMI对照组,两组均应用常规抗凝、抗血小板治疗,肾功能不全组于穿刺成功后开始应用半剂量替罗非班,AMI对照组全量应用替罗非班。比较两组间住院期主要不良心血管事件（MACE）,出血、血小板减少发生率及对比剂肾病发生率的差异。结果：与AMI对照组比较,肾功能不全组3支病变比例（21．1％比43．60）、术后肌酸激酶峰值浓度[（1863．1±86．7）IU／L比（2371．5±126．3）IU／L]明显升高（P均〈0．05）;两组术后TIMI3级血流率、校正的TIMI计帧数和Blush3级率未见显著性差异（P〉0．05）,术后2h心电图相关导联ST段下降幅度及住院期间的MACE发生率亦无显著性差异（P〉0．05）,出血事件发生率和血小板减少发生率亦无显著差异（P〉0．05）。对比剂肾病：AMI对照组无发生,肾功能不全组有3例发生（0％比5．45％,P〈0．05）。结论：合并早期。肾功能不全的急性心肌梗死患者三支病变比例高,半剂量替罗非班联合PCI能有效再灌注心肌,降低住院心血管事件发生,未见明显出血及血小板减少发生率增加,但需警惕对比剂肾病的发生,术后应加强监测与干预。     

替罗非班应用时机对急性ST段抬高心肌梗死急诊介入治疗的影响

目的观察早期应用替罗非班对急性ST段抬高心肌梗死(STEMI)急诊PCI效果的影响。方法将发病12 h急诊PCI的STEMI患者240例随机分为早期组(冠状动脉造影前1～3 h应用替罗非班)和即刻组(冠状动脉造影后即刻应用替罗非班),每组120例。观察2组PCI前后TIMI血流分级和梗死区心肌灌注(TMP)分级,PCI后30 d主要不良心血管事件(MACE)情况。结果与即刻组比较,早期组PCI前TIMI 3级血流和TMP 3级比例明显升高(30.8% vs 10.8%,33.3% vs 12.5%,P0.05);早期组PCI后TMP 3级明显升高(77.5% vs 51.7%,P0.05)。早期组发生MACE 3例,即刻组4例(2.5% vs 3.3%,P0.05)。结论对STEMI急诊PCI的患者,早期应用替罗非班能改善梗死相关血管的血流及心肌灌注。     

退行性心脏瓣膜病对老年急性心肌梗死患者冠脉病变情况及PCI近期疗效的影响

目的探讨退行性心脏瓣膜病（degenerative heart valve disease,DHVD）对老年冠状动脉粥样硬化性心脏病（冠心病）急性心肌梗死（acute myocardial infarction,AMI）患者冠状动脉病变情况及行经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗近期疗效的影响。方法回顾性分析69例65岁以上老年冠心病AMI行PCI治疗患者的临床资料,根据心脏超声检查分为DHVD组（n=30）和对照组（n=39）,对比两组冠状动脉造影（CAG）结果、PCI治疗情况、PCI治疗后心肌梗死溶栓试验（thrombolysis in myocardial infarction．TIMI）血流分级、1周内主要心血管事件发生率、1周时心脏收缩功能、舒张功能,血浆N末端脑钠肽前体（N-terminal pro—brain natriuretic peptide,NT-proBNP）浓度。结果冠状动脉造影显示,DHVD组与对照组相比,冠状动脉病变情况更加严重（病变程度评分：8．93±2．61vs7．09±1．99,P=0．047）;DHVD组PCI治疗后TIMI血流分级较对照组差（平均秩次：939．50vs1475．50,P〈O．05）;术后l周DHVD组恶性心律失常的发病率较对照组高（P〈0．05）,其余主要心血管事件事件的发生两组对比,差异无统计学意义（P〉0．05）。对照组PCI治疗后左心室射血分数高于DHVD组,差异有统计学意义（55．26％±5．75％眠48．49％±8．26％,P=0．049）;对照组和DHVD组E／A大于1．2的患者分别为64．1％（25／39）,36．7％（11／30）,两组比较差异有统计学意义（P=O．033）：对照组NT—proBNP浓度高于DHVD组,差异有统计学意义[（1874．89±101．31）pg·mL^-1（2025．87±108．04）Pg·mL^-1,P=O．038]。结论合并DHVD对老年冠心病AMI患者PCI治疗后近期预后有不良影响。     

冠脉内注射尿激酶原对AMI患者急诊PCI术后心肌微循环的影响

目的:探讨冠脉内注射重组人尿激酶原(rhPro-UK)对急性心肌梗死(AMI)患者急诊经皮冠脉介入治疗(PCI)术后心肌微循环的影响。方法:2016年7月~2017年12月我院的90例行PCI治疗的AMI患者被随机均分为PCI对照组(单纯急诊PCI)和联合治疗组(先冠脉内注射rhPro-UK,再行急诊PCI)。比较两组PCI术后即刻TIMI血流分级、校正的TIMI血流帧数(CTFC)、TIMI心肌灌注分级(TMPG),及PCI术前、24h后外周血肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平,并记录两组30d内主要不良心血管事件(MACE)及出血事件发生情况。结果:术后即刻,与PCI对照组比较,联合治疗组TIMI 3级比例(75.56%比91.11%)、TMPG 3级比例(71.11%比93.33%)均显著升高,CTFC[(30.62±4.94)帧比(24.84±5.29)帧]显著降低,P<0.05或<0.01。两组术后24h外周血CK-MB、cTnI水平均显著升高;与PCI对照组比较,联合治疗组术后24h CK-MB[(34.26±5.64)ng/ml比(29.68±4.49)ng/ml]、cTnI[(9.85±2.36)ng/ml比(8.25±2.13)ng/ml]水平显著降低,P均=0.001。联合治疗组30d内MACE发生率显著低于PCI对照组(15.56%比35.56%),P=0.030;两组30d内出血事件发生率无显著差异,P=0.535。结论:冠脉内注射尿激酶原能够显著改善AMI患者急诊PCI术后心肌微循环灌注,减轻心肌损伤,降低30d内MACE发生率,且不显著增加出血风险。     

急性心肌梗死合并新发右束支阻滞的临床特征及其在急诊再灌注决策中的价值

目的摇探讨急性心肌梗死（AMI）合并新发右束支阻滞（RBBB）临床特征及其在急诊再灌注治疗决策中的价值。方法摇回顾性收集538例接受急诊介入诊疗AMI患者的临床资料,分为新发RBBB组、无束支阻滞（BBB）组和新发左束支阻滞（LBBB）组;比较3组临床基线资料、急诊冠状动脉造影及院内主要不良心脏事件（MACE）发生率;筛选AMI患者出现新发RBBB及住院期间发生MACE事件的独立预测因素。结果摇 AMI患者合并新发RBBB的发生率为6. 32%,多见于左前降支（LAD）（52. 94%）近段（42. 98%）完全闭塞,其次为右冠状动脉（RCA）（38. 24%）近段（28. 96%）。与无BBB组相比,新发RBBB组患者心功能分级域级以上比率（Killip）、CKMB峰值更高;梗死相关血管（IRA）前向TIMI血流0/1级比率、IRA近段闭塞比率、急诊接受经皮冠状动脉介入治疗（PCI）比率（91. 18% vs 69. 04%）[OR=4. 634（95% CI 1. 395-15. 399）,P= 0. 012]以及住院期间MACE事件发生率（61.76% vs 17. 36%,P〈0. 001）更高;与新发LBBB组相比,新发RBBB组CKMB峰值较低,IRA前向TIMI血流0/1级比率和接受急诊PCI比率（91. 18% vs 57. 69%）[OR=7. 578（95% CI 1. 836 -31. 277）,P=0. 005]更高,超急期二者的检出率、IRA近段闭塞比率及院内MACE事件发生率（61. 76% vs 46. 15%,P=0. 660）无明显差异。 Logistic回归逐步法分析显示患者的IRA前向TIMI血流0/1级及IRA近段闭塞与是否出现新发RBBB呈正相关。 COX回归比例风险模型逐步分析显示新发RBBB（RR=3. 33,P〈0. 001）、新发LBBB（RR=2. 97,P〈0. 001）均为院内MACE事件的独立预测因素。结论摇新发RBBB多为LAD或RCA近段完全闭塞所致,临床症状重、住院期间MACE事件发生率高,且可出现在AMI超急期,同新发LBBB一样同为住院期间发生MACE事件的独立因素,故其应作为急诊再灌注治疗的指证。     

提前应用替罗非班对急性ST段抬高心肌梗死患者急诊介入治疗疗效的影响

目的通过随机对比分析,探讨急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)时,提前应用血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班是否安全,以及能否进一步改善急诊PCI疗效。方法2005年4月至2006年4月,160例拟诊急性STEMI的患者接受急诊PCI时联合应用替罗非班,最终158例患者纳入研究,其中男性117例,女性41例,平均年龄58.8±25.2岁(36～78岁)。将患者随机分为两组,第一组共80例,在急诊冠状动脉造影结束后开始应用为常规使用组,第二组78例,在获取知情同意后在急诊室即开始应用者为早期使用组。比较两组间的基础临床状况、术前梗死相关血管前向血流情况,术后血流情况以及出血事件与近期心血管事件。结果两组基础临床情况差异无统计学意义,早期使用组提前39.8min应用替罗非班。早期组术前IRA前向血流达到TIMI2～3级的比率高于常规组(分别为39.7%和23.8%,P=0.040),其中达到TIMI3级的比率亦显著高于常规组(分别为23.1%和10.0%,P=0.032)。两组术后TIMI3级获得率,校正的TIMI计帧数和Blush3级获得率差异无统计学意义。两组近期主要心血管事件发生率、出血事件与血小板减少症发生率差异无统计学意义。结论急性STEMI患者急诊PCI前提前应用替罗非班是安全的,虽然术后造影结果和临床预后并没有明显改善,但是提前应用替罗非班可以提高PCI前的梗死相关血管前向血流。需要设计更大的样本量,更早的应用时机和合适的较大剂量提前应用替罗非班进一步深入研究。     

Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction.

AIM: To evaluate the long-term outcome of a nonoptimal result of a primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). METHODS AND RESULTS: An optimal PCI result was defined as TIMI flow grade 3 and residual stenosis < or = 20%. Long-term clinical follow-up (51 +/-+/- 21 months) data were collected from 1,009 consecutive patients with ST-elevation AMI who underwent primary PCI. Overall, an optimal primary PCI result was achieved in 958 patients (95%). At 5-year follow-up, patients with nonoptimal PCI had a higher rate of all-cause mortality (47% vs 19%; P < 0.00001 by log-rank test) than those with an optimal mechanical reperfusion. Fifty-two percent of the deaths in the nonoptimal PCI group occurred within the first month. Interestingly, after this period, estimated survival of 30-day alive patients was not significantly different to that of patients with an optimal PCI (P = 0.06 by log-rank test). Nonoptimal PCI result emerged as an independent predictor of 1-month mortality (OR = 3.030, 95% CI = 1.265-7.254; P = 0.013), but not of 5-year mortality. At long-term follow-up, cumulative rates of nonfatal reinfarction, hospitalization for heart failure, and additional revascularization procedures were similar between patients with nonoptimal and optimal primary PCI (4% vs 5%, P = 0.695; 4% vs 5%, P = 921; and 22% vs 20%, P = 0.816, respectively). CONCLUSION: A nonoptimal primary PCI result represents a strong predictor of early mortality. However, in patients surviving the early phase, the incidence of clinical events at long-term follow-up seems to be similar to successfully reperfused AMI patients.     

Results of primary percutaneous transluminal coronary angioplasty plus abciximab with or without stenting for acute myocardial infarction complicated by cardiogenic shock.

This study examines the effects of abciximab as adjunctive therapy in primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) complicated by cardiogenic shock. Abciximab improves the outcome of primary PTCA for AMI, but its efficacy in cardiogenic shock remains unknown. Case report forms were completed in-hospital and follow-up was obtained by telephone, outpatient visit, and review of hospital readmission records. A total of 113 patients with cardiogenic shock from AMI were included. All underwent emergency PTCA during which abciximab was administered to 54 patients (48%). The 2 groups of patients who received and did not receive abciximab were similar at baseline. Coronary stents were implanted slightly more often in the abciximab group (59% vs 42%; p = 0.1). A significantly improved final TIMI flow, less no-reflow, and a decrease in vessel residual diameter stenosis occurred in the abciximab group. At 30-day follow-up, the composite event rate of death, myocardial reinfarction, and target vessel revascularization was better in the abciximab group (31% vs 63%; p = 0.002). The combination of abciximab and stents was synergistic and resulted in improvement of all components of the composite end point beyond that seen with each therapy alone. Thus, abciximab therapy improves the 30-day outcome of primary PTCA in cardiogenic shock, especially when combined with coronary stenting.     

急性心肌梗死急诊介入治疗无再流发生的独立预测因素及对长期预后的影响

目的探讨急性心肌梗死(AMI)患者接受急诊经皮冠状动脉介入治疗(PCI)术中发生无再流的相关因素,并评估无再流对于该类患者的长期预后意义。方法930例行急诊PCI的AMI患者依其是否发生无再流分为两组,分析无再流发生的危险因素及两组患者院内和长期随访中主要不良心脏事件(MACE)。结果930例患者中共82例发生无再流(8.8%)。与正常血流组相比,无再流组患者的入院血糖水平[(9.8±4.3)mmol/L比(8.5±3.5)mmol/L,P<0.01]、肌酸激酶同工酶(CK-MB)峰值[(369.4±167.8)U/L比(282.3±161.7)U/L,P<0.01]、PCI术前0级血流(69.5%比54.5%,P=0.009)发生率较高,AMI前心绞痛发生率较低(19.5%比48.1%,P<0.01)。Logistic回归分析显示入院血糖水平、缺乏AMI前心绞痛、PCI术前0级血流及严重心力衰竭是无再流发生的独立预测因素。无再流患者院内MACE(37.8%比11.3%,P<0.01)和院后(2.5±1.2)年随访MACE发生率(37.5%比17.4%,P<0.01)均显著高于正常血流患者,Kaplan-Meier生存分析提示无再流组患者心因性病死率明显高于正常血流组患者(29.9%比11.7%;logrank检验,P<0.001)。Cox回归分析显示无再流是AMI患者长期心因性病死率的独立预测因素(相对危险度3.83,95%可信区间1.71~5.57)。结论入院血糖水平、缺乏AMI前心绞痛、PCI术前0级血流及严重心力衰竭是无再流发生的独立预测因素。与正常血流组相比,无再流组患者院内及长期随访MACE发生率分别增高3.3和2.2倍。     

Comparison of abciximab combined with dalteparin or unfractionated heparin in high-risk percutaneous coronary intervention in acute myocardial infarction patients

The purpose of this study was to determine the clinical outcomes of abciximab combined with the low molecular weight heparin (LMWH), dalteparin, in high-risk percutaneous coronary intervention (PCI) patients with acute myocardial infarction (AMI). A total of 140 high-risk PCI patients with AMI were divided into 2 groups: unfractionated heparin (UFH) with abciximab (group I: 70 patients, 58.7 +/- 10.5 years), and dalteparin with abciximab (group II: 70 patients, 59.6 +/- 9.8 years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Baseline clinical characteristics, laboratory findings, echocardiography parameters, and baseline angiographic characteristics were not different between the 2 groups. The incidence of thrombotic total occlusion lesions was 62.9% in both groups. Procedural success was achieved in 91.4% in group I and 90.0% in group II. Bleeding and hemorrhagic events were not different between the 2 groups. No significant intracranial bleeding was observed in either group. The incidence of in-hospital MACE was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed in 97% of the patients. Four years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) in group II. MI occurred in 4 (5.7%) and 4 (5.7%), target vessel revascularization (TVR) in 23 (32.9%) and 16 (22.9%), and bypass surgery in 3 (4.3%) and 1 (1.4%), respectively. Overall, a MACE occurred in 33 (47.1%) patients in group I and in 26 (35.1%) patients in group II (P = 0.23). The long-term clinical outcome with dalteparin combined with abciximab may be comparable to that of UFH plus abciximab in high risk PCI patients with AMI.     

Predictive factors of major adverse cardiac events in acute myocardial infarction patients complicated by cardiogenic shock undergoing primary percutaneous coronary intervention.

BACKGROUND: The aim of this study was to assess in-hospital mortality and major adverse cardiac events (MACE) during long-term clinical follow-up of patients who developed cardiogenic shock (CS) after acute myocardial infarction (AMI) and who underwent primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: The data from 147 patients with CS after AMI (61.7 +/-10.4 years, M:F =156:99) who underwent primary PCI at Chonnam National University Hospital between January 1999 and December 2002 were analyzed: clinical characteristics, coronary angiographic findings and mortality during admission, and MACE during a 1-year clinical follow-up. Of the enrolled patients, 121 patients survived (group I, M:F =94:27) and 26 died (group II, M:F =14:12) during admission. By binary logistic regression analysis, in-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization (p=0.02, odds ratio (OR) =1.3). Eighty-nine patients (60.5%) survived without MACE during the 1-year clinical follow-up and MACE was associated with a C-reactive protein (CRP) of more than 1 mg/dl (p=0.002, OR =6.3) and low TIMI flow after coronary revascularization (p<0.001, OR =7.8). CONCLUSIONS: Primary PCI achieving TIMI 3 flow reduces in-hospital death in AMI with CS. High concentration of CRP and low TIMI flow are associated with MACE during long-term clinical follow-up.     

Clinical impact of abciximab on long-term outcome after complex coronary angioplasty.

Glycoprotein IIb/IIIa receptor antagonists, such as abciximab, are used to reduce major adverse cardiac events (MACEs) in patients undergoing percutaneous transluminal coronary angioplasty. The goal of this study was to evaluate the administration of abciximab in relation to lesion complexity and periprocedural complications. A total of 357 patients with 435 de novo lesions were included in this study. Lesions were divided into simple (type A and type B1) and complex (type B2 and type C) lesions according to the American College of Cardiology/American Heart Association Task Force lesion complexity system. Abciximab was given to unstable complex lesions and simple lesions with a periprocedural unstable complicated course. The overall incidence of MACE during the 9-month follow-up period was 17.0%. Patients treated with abciximab had a higher lesion complexity (P < 0.001), dissections (P = 0.014), stents (P < 0.001), and vessels involved (P < 0.001). in addition, the abciximab group was characterized by a higher angina NYHA class (P = 0.005), lower TIMI flow prior to stenting (P = 0.01), and a longer total inflation time (P = 0.006). Despite these clinical differences, the occurrence of MACE within the abciximab group was slightly less than in the group without abciximab (16.2% and 17.3%, respectively). Lesion complexity was directly related to MACE in the group that did not receive abciximab (simple and stable complex lesions; P = 0.04). On the other hand, in subjects treated with abciximab, lesion complexity was not related to a higher incidence of MACE (P = 0.76). The use of abciximab equalizes the difference in outcome between simple and complex lesions. Therefore, abciximab should be advocated especially in unstable and complex percutaneous coronary interventions.     

经两种导管注射地尔硫卓处理急诊PCI术中无复流现象的疗效比较

目的:观察急诊经皮冠状动脉介入治疗(PCI)术中出现无复流现象后,经微导管向远端血管床注射地尔硫卓的治疗效果。方法:选择PCI治疗中存在“无复流”现象的患者41例为研究对象,其中20例入选导引导管组,经导引导管冠状动脉内注射地尔硫卓2.0 mg;21例入选微导管组,经微导管注射地尔硫卓2.0 mg至靶病变远端:10 min后复查冠状动脉造影,观察两组患者首次和手术结束前末次造影图像,评定冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及TIMI心肌组织灌注分级(TMPG)、1周内住院期间主要心脏不良事件(MACE)事件。结果:2组均可改善PCI治疗后的“无复流”现象。微导管组手术结束前末次造影TIMIⅢ级比例明显高于导引导管组[95%(20/21)vs.40%(8/20),P<0.05],而且手术结束前末次造影TIMI心肌组织灌注分级(TMPG)Ⅲ级亦较高(90%vs.35%,P<0.05),减少1周内住院期间MACE事件(5%vs.30%,P<0.05)。结论:与经导引导管相比,经微导管注射地尔硫卓明显改善急诊PCI术中无复流现象。