Periprocedural abciximab administration in ST elevation myocardial infarction patients. Effect on severe microvascular obstruction beyond the restoration of epicardial coronary flow by primary angioplasty.

摘要

OBJECTIVES: The impact of periprocedural (before primary percutaneous coronary angioplasty, PCI) abciximab administration on microvascular obstruction in patients with occluded infarct-related artery (IRA) is unknown. METHODS: We studied 36 consecutive patients with first ST elevation myocardial infarction (STEMI) and occluded IRA treated with successful primary PCI within 12 h from symptom onset, who received intravenous abciximab immediately before PCI and 49 matched patients who did not receive abciximab as controls. All patients underwent delayed-enhanced magnetic resonance (DE-MR) 6 +/- 2 days after PCI. Necrosis was judged as transmural when DE was extended to > or =75% of left ventricular (LV) segment thickness. Severe microvascular obstruction was identified as areas of late hypoenhancement surrounded by DE. RESULTS: Time to treatment was comparable in the two groups (182 +/- 60 vs. 188 +/- 110 min, respectively). Transmurality and severe microvascular obstruction were present in 3.03 +/- 2.8 versus 3.09 +/- 2.9 (p = 0.9) and 1.05 +/- 1.5 versus 1.06 +/- 1.8 (p = 0.6) of LV segments, respectively, in the abciximab group versus controls. At multivariate analysis, severe microvascular obstruction was independently associated only with transmural necrosis (OR 1.5, p < 0.001) and age (OR 1.1, p = 0.02) but not with the use of abciximab. CONCLUSIONS: Severe microvascular obstruction after primary PCI of STEMI patients with occluded IRA is related to transmural necrosis but not to the use of abciximab.