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Circulation. 1998;98:2695-2701

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(Circulation. 1998;98:2695-2701.)
© 1998 American Heart Association, Inc.


Clinical Investigation and Reports

Effect of Glycoprotein IIb/IIIa Receptor Blockade on Recovery of Coronary Flow and Left Ventricular Function After the Placement of Coronary-Artery Stents in Acute Myocardial Infarction

Franz-Josef Neumann, MD; Rudolf Blasini, MD; Claus Schmitt, MD; Eckhard Alt, MD; Josef Dirschinger, MD; Meinrad Gawaz, MD; Adnan Kastrati, MD; Albert Schömig, MD

From the Deutsches Herzzentrum and 1. Medizinische Klinik der Technischen Universität München, Munich, Germany.

Correspondence to Franz-Josef Neumann, MD, Deutsches Herzzentrum und 1. Medizinische Klinik der Technischen Universität, Lazarettstraße 36, 81636 München, Germany. E-mail neumann{at}dhm.mhn.de

Background—Apart from its established effects on vessel patency after percutaneous coronary revascularization, glycoprotein IIb/IIIa receptor blockade by abciximab may improve myocardial perfusion by inhibition of the interaction of platelets and platelet aggregates with the microvasculature. We investigated the effect of abciximab with stent placement in acute myocardial infarction.

Methods and Results—In a prospective randomized trial, patients undergoing stenting in acute myocardial infarction within 48 hours after onset of symptoms were randomly assigned to receive either standard-dose heparin or abciximab plus low-dose heparin. Immediately after the procedure and at 14-day angiographic follow-up, we assessed flow velocity in the recanalized vessel with the Doppler wire and regional wall motion by the centerline method. End points were changes in papaverine-induced peak flow velocities and in wall motion indices. We assigned 98 patients to standard heparin and 102 to abciximab. We obtained 152 paired flow measurements and 151 paired left ventricular function studies. Residual stenoses of the treated lesions did not differ between the 2 groups. Improvement of peak flow velocity (mean [95% CI]: 18.1 cm/s [13.6 to 22.6 cm/s], n=80, versus 10.4 cm/s [5.4 to 15.4 cm/s], n=72, P=0.024) and wall motion index (0.44 SD/chord [0.29 to 0.59 SD/chord], n=79 versus 0.15 SD/chord [0.00 to 0.30 SD/chord], n=72, P=0.007) was significantly greater in patients assigned to abciximab than in those on heparin alone. At follow-up, the abciximab group had a higher global left ventricular ejection fraction than the heparin group (62% [59% to 65%] versus 56% [53% to 59%], P=0.003).

Conclusions—Abciximab had important effects beyond the maintenance of large-vessel patency. It improved the recovery of microvascular perfusion and concomitantly enhanced the recovery of contractile function in the area at risk.


Key Words: myocardial infarction • stents • glycoproteins • blood flow • ventricles




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D. Antoniucci, A. Rodriguez, A. Hempel, R. Valenti, A. Migliorini, F. Vigo, G. Parodi, C. Fernandez-Pereira, G. Moschi, A. Bartorelli, et al.
A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1879 - 1885.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
H. C. Herrmann
Optimizing outcomes in ST-segment elevation myocardial infarction
J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1357 - 1359.
[Full Text] [PDF]


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J Am Coll CardiolHome page
M. Napodano, G. Pasquetto, S. Sacca, C. Cernetti, V. Scarabeo, P. Pascotto, and B. Reimers
Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction
J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1395 - 1402.
[Abstract] [Full Text] [PDF]


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The Annals of PharmacotherapyHome page
P. P Dobesh, S. L Lanfear, J. R Abu-Shanab, J. E Lakamp, S. Gowda, and M. Y Haikal
Outcomes with Changes in Prescribing of Glycoprotein IIb/IIIa Inhibitors in PCI
Ann. Pharmacother., October 1, 2003; 37(10): 1375 - 1380.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. E. Tcheng, D. E. Kandzari, C. L. Grines, D. A. Cox, M. B. Effron, E. Garcia, J. J. Griffin, G. Guagliumi, T. Stuckey, M. Turco, et al.
Benefits and Risks of Abciximab Use in Primary Angioplasty for Acute Myocardial Infarction: The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial
Circulation, September 16, 2003; 108(11): 1316 - 1323.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Heitzer, I. Ollmann, K. Koke, T. Meinertz, and T. Munzel
Platelet Glycoprotein IIb/IIIa Receptor Blockade Improves Vascular Nitric Oxide Bioavailability in Patients With Coronary Artery Disease
Circulation, August 5, 2003; 108(5): 536 - 541.
[Abstract] [Full Text] [PDF]


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CirculationHome page
L. J. Feldman, P. Coste, A. Furber, P. Dupouy, M. S. Slama, J.-P. Monassier, C. Tron, A. Lafont, M. Faraggi, D. Le Guludec, et al.
Incomplete Resolution of ST-Segment Elevation Is a Marker of Transient Microcirculatory Dysfunction After Stenting for Acute Myocardial Infarction
Circulation, June 3, 2003; 107(21): 2684 - 2689.
[Abstract] [Full Text] [PDF]


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The Annals of PharmacotherapyHome page
M. A Crouch, J. M Nappi, and K. I Cheang
Glycoprotein IIb/IIIa Receptor Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndrome
Ann. Pharmacother., June 1, 2003; 37(6): 860 - 875.
[Abstract] [Full Text] [PDF]


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CirculationHome page
C. L. Grines, P. Serruys, and W. W. O'Neill
Fibrinolytic Therapy: Is It A Treatment of the Past?
Circulation, May 27, 2003; 107(20): 2538 - 2542.
[Full Text] [PDF]


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Eur Heart JHome page
S. J. Brener, S. G. Ellis, J. Schneider, C. Apperson-Hansen, and E. J. Topol
Abciximab-facilitated percutaneous coronary intervention and long-term survival--a prospective single-center registry
Eur. Heart J., April 1, 2003; 24(7): 630 - 638.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Dibra, J. Mehilli, J. Dirschinger, J.u. Pache, J. Neverve, M. Schwaiger, A. Schomig, and A. Kastrati
Thrombolysis in myocardial infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis
J. Am. Coll. Cardiol., March 19, 2003; 41(6): 925 - 929.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. K. Haager, P. Christott, N. Heussen, W. Lepper, P. Hanrath, and R. Hoffmann
Prediction of clinical outcome after mechanical revascularization in acute myocardial infarction by markers of myocardial reperfusion
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 532 - 538.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
K.M.J. Marques and C.A. Visser
Myocardial contrast echocardiography in the assessment of pharmacologic intervention of the reperfusion injury
Eur. Heart J., January 1, 2003; 24(1): 19 - 20.
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Eur Heart JHome page
A.S Petronio, D Rovai, G Musumeci, R Baglini, C Nardi, U Limbruno, C Palagi, D Volterrani, and M Mariani
Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty
Eur. Heart J., January 1, 2003; 24(1): 67 - 76.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. Marzilli, G. Sambuceti, R. Testa, and S. Fedele
Platelet glycoprotein IIb/IIIa receptor blockade and coronary resistance in unstable angina
J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2102 - 2109.
[Abstract] [Full Text] [PDF]


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HeartHome page
M Dalby and G Montalescot
Transfer for primary angioplasty: who and how?
Heart, December 1, 2002; 88(6): 570 - 572.
[Abstract] [Full Text] [PDF]


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Eur Heart J SupplHome page
F.-J. Neumann and N. Jander
How to best counteract the enemies? By ensuring adequate oxygen delivery
Eur. Heart J. Suppl., November 1, 2002; 4(suppl_G): G35 - G42.
[Abstract] [PDF]


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CirculationHome page
M. J. Kern
Patterns of Left Ventricular Dilatation With an Opened Artery After Acute Myocardial Infarction: Missing Links to Long-Term Prognosis
Circulation, October 29, 2002; 106(18): 2294 - 2295.
[Full Text] [PDF]


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J. Leukoc. Biol.Home page
C. Kupatt, R. Wichels, J. Horstkotte, F. Krombach, H. Habazettl, and P. Boekstegers
Molecular mechanisms of platelet-mediated leukocyte recruitment during myocardial reperfusion
J. Leukoc. Biol., September 1, 2002; 72(3): 455 - 461.
[Abstract] [Full Text] [PDF]


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NEJMHome page
H. C. Herrmann, G. W. Stone, C. L. Grines, and J. E. Tcheng
Comparison of Angioplasty with Stenting in Acute Myocardial Infarction
N. Engl. J. Med., August 1, 2002; 347(5): 367 - 368.
[Full Text] [PDF]


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J Am Coll CardiolHome page
T. Palmerini, M. A. Nedelman, L. E. Scudder, M. T. Nakada, R. E. Jordan, S. Smyth, R. E. Gordon, J. T. Fallon, and B. S. Coller
Effects of abciximab on the acute pathology of blood vessels after arterial stenting in nonhuman primates
J. Am. Coll. Cardiol., July 17, 2002; 40(2): 360 - 366.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J.P.S. Henriques, F. Zijlstra, J.P. Ottervanger, M.-J. de Boer, A.W.J. van 't Hof, J.C.A. Hoorntje, and H. Suryapranata
Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction
Eur. Heart J., July 2, 2002; 23(14): 1112 - 1117.
[Abstract] [Full Text] [PDF]


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CirculationHome page
E. D. Aymong, M. J. Curtis, M. Youssef, M. M. Graham, L. Shewchuk, W. Leschuk, and T. J. Anderson
Abciximab Attenuates Coronary Microvascular Endothelial Dysfunction After Coronary Stenting
Circulation, June 25, 2002; 105(25): 2981 - 2985.
[Abstract] [Full Text] [PDF]


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HeartHome page
S Constantinides, T S N Lo, M Been, and M F Shiu
Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis.
Heart, May 1, 2002; 87(5): 455 - 460.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. A. Ambrose and E. E. Martinez
A New Paradigm for Plaque Stabilization
Circulation, April 23, 2002; 105(16): 2000 - 2004.
[Abstract] [Full Text] [PDF]


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HeartHome page
P Andrassy, M Zielinska, R Busch, A Schomig, and C Firschke
Myocardial blood volume and the amount of viable myocardium early after mechanical reperfusion of acute myocardial infarction: prospective study using venous contrast echocardiography
Heart, April 1, 2002; 87(4): 350 - 355.
[Abstract] [Full Text] [PDF]


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NEJMHome page
G. W. Stone, C. L. Grines, D. A. Cox, E. Garcia, J. E. Tcheng, J. J. Griffin, G. Guagliumi, T. Stuckey, M. Turco, J. D. Carroll, et al.
Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction
N. Engl. J. Med., March 28, 2002; 346(13): 957 - 966.
[Abstract] [Full Text] [PDF]


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HeartHome page
B R Brodie and T D Stuckey
Mechanical reperfusion therapy for acute myocardial infarction: Stent PAMI, ADMIRAL, CADILLAC and beyond
Heart, March 1, 2002; 87(3): 191 - 192.
[Full Text] [PDF]


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J Am Coll CardiolHome page
G. W. Stone, M. A. Peterson, A. J. Lansky, G. Dangas, R. Mehran, and M. B. Leon
Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction
J. Am. Coll. Cardiol., February 20, 2002; 39(4): 591 - 597.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. H. Rezkalla and R. A. Kloner
No-Reflow Phenomenon
Circulation, February 5, 2002; 105(5): 656 - 662.
[Full Text] [PDF]


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JAMAHome page
J. Mehilli, A. Kastrati, J. Dirschinger, J. Pache, M. Seyfarth, R. Blasini, D. Hall, F.-J. Neumann, and A. Schomig
Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention
JAMA, January 9, 2002; 287(2): 210 - 215.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
C. Loubeyre, M.-C. Morice, T. Lefevre, J.-F. Piechaud, Y. Louvard, and P. Dumas
A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction
J. Am. Coll. Cardiol., January 2, 2002; 39(1): 15 - 21.
[Abstract] [Full Text] [PDF]