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(Circulation. 2000;101:239.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Abciximab Improves Both Epicardial Flow and Myocardial Reperfusion in ST-Elevation Myocardial Infarction
Observations from the TIMI 14 Trial
From the Cardiovascular Division, Brigham and Women’s Hospital (J.A.d., E.M.A., C.H.M., R.P.G., S.A.C., E.B.), Boston Mass; University of California at San Francisco Medical Center (C.M.G., S.A.M.), San Francisco; Centocor (K.A.), Malvern, Pa; Eli Lilly Inc (J.S.), Indianapolis, Ind; Heart Center (M.J.F.), Sarasota, Fla; Afdeling Cardiologie (R.V.), Amsterdam, the Netherlands; and Universitair Zikenhuis Gasthuisberg (F.V.), Leuven, Belgium.
Correspondence to James A. de Lemos, MD, Brigham and Women’s Hospital, Division of Cardiology, 75 Francis Street, Boston, MA 02115. E-mail jdelemos{at}rics.bwh.harvard.edu
Background—In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation.
Methods and Results—All 346 patients with interpretable baseline
and 90-minute ECGs, treated with either tPA alone or abciximab plus
reduced-dose tPA (combination therapy), were included. Patients
receiving combination therapy (n=221) had a 59% rate of complete
(
70%) ST resolution at 90 minutes versus 37% in those treated with
tPA alone (n=125) (P<0.0001). When the analysis
was limited to patients with TIMI 3 flow, patients treated with
combination therapy (n=151) remained significantly more likely to
achieve complete ST resolution than those receiving tPA alone (n=80)
(69% versus 44%; P=0.0002).
Conclusions—Combination therapy with abciximab and reduced-dose tPA improves myocardial (microvascular) reperfusion, as reflected in greater ST-segment resolution, in addition to epicardial flow. This finding may translate into improved clinical outcomes by enhancing myocardial salvage.
Key Words: myocardial infarction • thrombolysis • reperfusion • electrocardiography • microcirculation
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