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.

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).