By Marvin Ross
TORONTO -- October 29, 2008 -- The rapid administration of abciximab in regional hospitals before patients are transferred for primary percutaneous coronary intervention (PCI) is associated with better postprocedure microvascular circulation, according to research presented here at the Canadian Cardiovascular Congress (CCC).
Thrombolysis in myocardial infarction (TIMI) myocardial perfusion grades (TMPG) are used as a measure of microvascular circulation in patients treated for acute myocardial infarction. In this study, the final TMPG appeared to be dependent on the ischaemic time and the rapidity of abciximab administration prior to primary PCI, noted lead investigator Philippe Genereux, MD, Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, speaking here at a poster presentation on October 26.
Previous research has suggested that the early administration of glycoprotein IIb/IIIa inhibitors prior to PCI in ST-segment elevation MI (STEMI) may improve angiographic and clinical outcomes. Since improved TMPG at the end of the procedure has been well correlated with better outcomes after reperfusion therapy for STEMI, the researchers hypothesised that rapid abciximab administration as adjuvant therapy before transfer would result in better post-PCI myocardial perfusion.
In this study, the records of a total of 348 consecutive patients at Hopital du Sacre-Coeur de Montreal and the Université de Montreal, both in Montreal, Quebec, were examined. All subjects were transferred with STEMI for primary PCI from January 2004 to January 2008 and were administered abciximab as adjuvant therapy. Hospital charts and angiograms were reviewed to determine clinical outcomes. TMPG was reliably available in 83 patients, and time intervals were calculated from a prospective time-flow chart for each patient and cross-checked with hospital charts and procedural logs.
Ischaemic time; onset of pain to abciximab-administration time; community-hospital door to abciximab-administration time; and door-to-balloon time were calculated.
Among the 83 patients, 32% had TMPG 3, and 68% had TMPG 0, 1, or 2 (poor myocardial perfusion). Bivariate analyses were performed to identify factors associated with TMPG 0, 1, or 2. Those factors were older age (P = .04), ischaemic time >180 minutes (odds ratio [OR] 5.3; 95% confidence interval [CI], 1.9-14.5, P = .001), and community-hospital door to abciximab-administration time >30 minutes (OR 11.4; 95% CI, 3.6-35.9, P < .0001).
Multivariate analyses were conducted by logistical regression adjusted for age, diabetes, obesity, tobacco use, statin use before STEMI and presence of collateral on angiogram. Ischaemic time >180 min (OR 3.85; 95% CI, 1.05-11.41, P = .04) and community-hospital door to abciximab-administration time >30 minutes (OR 17.10; 95% CI, 3.67-79.35, P < .01) were associated with poor TMPG.
[Presentation title: Early Abciximab Administration as Adjuvant Therapy for ST Elevation Myocardial Infarction Before Transfer for Primary Percutaneous Intervention From Regional Hospital Center Improves Myocardial Perfusion. Abstract 113-051]
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