QJM Advance Access originally published online on July 22, 2005
QJM 2005 98(9):633-641; doi:10.1093/qjmed/hci097
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Review |
Coronary stenting and abciximab in primary angioplasty for ST-segment-elevation myocardial infarction
From the 1Division of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands, and 2Division of Cardiology, ‘Federico II’ University, Naples, Italy
Address correspondence to Dr H. Suryapranata, Division of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Groot Wezenland, 20, 8011 JW, Zwolle, The Netherlands. email: h.suryapranata{at}diagram-zwolle.nl
 |
Summary |
|---|
 Top Summary IntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
Advances in anti-platelet therapy and improvement of stent deployment techniques have improved the safety and efficacy of stenting in the setting of ST-segment-elevation myocardial infarction (STEMI). However, in randomized trials, routine coronary stenting does not reduce mortality and re-infarction, compared to balloon angioplasty. Further, the benefits in target vessel revascularization seem to be reduced when applied to unselected patients with STEMI. Direct stenting represents an attractive strategy with potential benefits in terms of myocardial perfusion. Future large randomized trials are needed to evaluate whether this strategy has a significant impact on outcome, and to provide a cost-benefit analysis of the unrestricted use of drug-eluting stents in this high-risk subset of patients. The additional use of abciximab reduces mortality in primary angioplasty. Since the feasibility of long-distance transportation has been shown in several randomized trials, early pharmacological pre-treatment may confer further advantages by early recanalization and shorter ischaemic time, particularly in high-risk patients. Further randomized trials are needed to clarify the potential benefits from early abciximab administration and the potential role of small molecules in primary angioplasty for STEMI.
|
Introduction |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
For several years, stenting has been avoided in the setting of ST-segment elevation myocardial infarction (STEMI), because the implantation of a metallic device within a thrombotic environment, such as that of a plaque disruption resulting in myocardial infarction, would be likely to precipitate stent thrombosis, with resultant vessel occlusion. Vigorous anti-coagulation, necessary to avoid stent thrombosis, exposes the patient to the risk of bleeding and vascular complications.1 All these considerations have led most investigators to restrict stenting in STEMI to bail-out situations. The improvement of stent deployment techniques and advances in anti-platelet therapy,2–5 however, have rendered stenting in the setting of STEMI safe and effective.6–17 We review currently available data on stenting and abciximab in primary angioplasty for STEMI.
|
Methods |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
We obtained results from all completed, published, trials of stenting and abciximab in STEMI. The literature was scanned by formal searches of electronic databases (MEDLINE, Pubmed) from January 1990 to December 2004, and the scientific session abstracts in Circulation, Journal of College of Cardiology, and European Heart Journal, from January 1999 to December 2004. The following key words were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, facilitated angioplasty, stenting, IIb-IIIa inhibitors, abciximab.
|
Stenting in primary angioplasty |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
Results from randomized trials
In the Zwolle-5 randomized trial,6 227 patients were randomly assigned to stent (n = 112) or balloon angioplasty (n = 115). This was the first randomized trial to show the safety of stenting in STEMI. Stenting was associated with a significant reduction in major adverse cardiac events, mostly due to benefits in target vessel revascularization. The benefits from stenting were stable at 2 years follow-up, resulting a cost-effective strategy for STEMI.7 Several additional trials have been conducted8–20 (Table 1) confirming these findings. In the stent PAMI trial,11 Grines and colleagues randomized 452 patients to a heparin-coated stent and 448 to balloon angioplasty. They found that the better outcome with stenting was mainly accounted for by a reduction in target-vessel revascularization (TVR) at 12 months follow-up, as compared with balloon angioplasty alone. There were however some concerns about the higher rate of mortality in the stent group (5.8% vs. 3.1%, p = NS). These results may be partially explained by the different levels of expertise in primary angioplasty at some of 65 participating centres, a hypothesis indirectly supported by the lower mortality rate (1.7%), observed in the PAMI pilot trial,17 where enrolment was limited to nine high-volume centres with experienced operators.
|
In the largest randomized trial conducted so far, the CADILLAC Trial,16 2082 patients were randomized to stenting with (n = 524) or without (n = 512) abciximab, or to balloon angioplasty with (n = 528) or without (n = 518) abciximab. Confirming the results of previous trials, stenting showed advantages in terms of TVR, without any additional benefits in terms of post-procedural TIMI flow, mortality or re-infarction.
A recent meta-analysis reported data involving a total of 4120 patients randomized to stent (n = 2050) or balloon angioplasty (n = 2070) in eight trials.18 Patients in cardiogenic shock were included in FRESCO,8 GRAMI,9 PASTA10 and PSAAMI,12 but were generally excluded in other trials. As shown in Figure 1, primary stenting reduced significantly the composite incidence of all adverse cardiac events, mainly due to a reduction in the need for TVR (9.2% vs. 18.7%; OR 0.43, 95%CI 0.36–0.52; p < 0.001), without statistically significant differences in mortality (3.75% vs. 3.6%; OR 1.04, 95%CI 0.75–1.44; p = NS) or reinfarction (2.1% vs. 2.9%; OR 0.71, 95%CI 0.47–1.08; p = 0.13).
|
Two recent trials performed by the Munich group have investigated the role of additional coronary stenting in patients ineligible for reperfusion therapy19 (defined on the basis of: presentation >12 h from symptoms onset, 40.1%; non-ST segment elevation myocardial infarction, 40.1%; or contraindication to thrombolysis, 19.8%), and in patients undergoing mechanical revascularization after failed thrombolysis.20 Stenting did not appear to improve myocardial salvage and outcome in patients ineligible to thrombolysis, whereas stenting was associated with better myocardial salvage in patients undergoing rescue angioplasty.
Limitations of current randomized trials
Despite the demonstrated superiority of stenting in comparison with balloon angioplasty in patients with STEMI, stenting has not produced a reduction in re-infarction and death. Therefore, caution should be taken in extending these data to the ‘real world’, because of the potential for selection bias that could have affected the results.
Role of randomization strategies
Four major randomization strategies can be identified, by time of randomization: (i) before the initial angiogram; (ii) before passing the guidewire across the occlusion; (iii) after crossing the lesion with the guide wire or initial balloon inflation; and (iv) after optimal balloon angioplasty.
In none of the trials randomization was done before the initial angiogram (Table 1). Currently available data have mainly been obtained from highly selected patients. In fact, knowledge of coronary anatomy before randomization may have excluded many patients who were considered non-suitable for stenting and those with unstable haemodynamic conditions. In our previous report,6 patients excluded from the trial had a significantly worse in-hospital outcome than those included in the study.
Actual treatment analysis
Most of the data available from randomized trials, and from meta-analysis studies, come from intention-to-treat analysis, whereas a variable percentage of cross-over was observed, according to the randomization strategy, ranging from 0% in the FRESCO trial8 to 35% in the STENTIM-2 trial.14
Small, low-volume centres
The results from many randomized trials were obtained from experienced centres. The results may not therefore be easily achievable in the community setting, as suggested by the results of large national registries.21 This issue has been addressed by the GUSTO IIb trial,22 by testing the effects of angioplasty when performed in low-volume centres on a low-risk population, with a less favourable outcome than in other trials.
Angiographic follow-up
As shown from the Benestent II trial,23 patients with angiographic follow-up have a significantly higher rate of TVR, compared with those without planned angiographic follow-up. This may have partially contributed to the benefits observed with coronary stenting in almost all previous randomized trials.
Zwelle-6 randomized trial
To overcome the above-mentioned limitations, we conducted a prospective randomized trial to investigate the actual role of routine stenting as compared to balloon angioplasty, in a large cohort of unselected, consecutive patients with STEMI, enrolled before the initial angiogram.24
No difference was observed in terms of procedural success (87.1% vs. 86.5%) or distal embolization (14.3% vs. 17.9%). At 1 year follow-up, stenting was not associated with benefits in terms of mortality and reinfarction (Table 2). Despite the significant reduction in re-stenosis observed with coronary stenting at angiographic follow-up (34.3% vs. 42.4%, p = 0.037), no difference in TVR was observed.
|
These results were confirmed when analysed according to final treatment (Table 2) and in those patients who did not undergo routine angiographic follow-up (Table 3).
|
Direct stenting in primary angioplasty
Recently, the availability of pre-mounted stents has allowed direct stenting to become, when technically feasible, a very attractive strategy, with significant reductions in costs and radiation exposure,25 and a better post-procedural flow, compared with conventional stenting.26 In animal models, direct stenting limits the extent of endothelial ablation and reduces neo-intimal hyperplasia.27 Thus, direct stenting seems very attractive in infarct-related arteries, where distal microembolization is common.28
Loubeyre et al.29 recently reported a single-centre study of 206 patients randomized to direct stenting or conventional stenting. The cumulative angiographic incidence of slow flow, no reflow or distal embolization occurred in 12 patients (11.7%) in the direct stenting group and in 28 patients (26.9%) in the conventional stent group (p = 0.01). Conventional stenting was associated with a significantly higher incidence of lack of ST-segment resolution. This study has definitively demonstrated the feasibility of direct stenting in patients with STEMI. In fact, when taking into account all patients with STEMI during the same period, but not included in the trial, direct stenting was feasible in 53% (216/409) of total primary stenting procedures.
The reduction in fluoroscopic and procedural time, and the feasibility of a direct stenting strategy in primary angioplasty, have been confirmed by the DIRAMI trial,30 in which 248 patients with STEMI were randomized to direct stenting or provisional stenting.
Drug-eluting stents in primary angioplasty
Re-stenosis still represents the Achilles heel of coronary angioplasty, making the possibility of ‘a local solution for a local problem’ a very attractive option. Although the benefits of drug-eluting stents on TVR have been shown in elective cases,31,32 and the initial results showed the feasibility of drug-eluting stents for STEMI,33 its safety for STEMI remains uncertain. The delayed re-endothelization of a drug-eluting stent may potentially be associated with higher rates of subacute thrombosis, with impairment of clinical outcome. Data from the Rotterdam registry,33 comparing 186 consecutive patients treated with sirolimus-eluting stent vs. 183 patients treated with bare stents for STEMI, showed a significant reduction in target vessel revascularization at 1 year follow-up (1.1% vs. 8.2%), without higher risk of sub-acute stent thrombosis. Future randomized studies, without strict inclusion criteria, should provide a cost-benefit analysis of the unrestricted use of drug-eluting stent in this high-risk subset of patients.
|
Abciximab in primary angioplasty |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
Rationale for glycoprotein IIb-IIIa inhibitors in primary angioplasty
The aim of a reperfusion therapy is to restore both epicardial (macrocirculation) and myocardial (microcirculation) flow. The strategy of incorporating IIb-IIIa inhibitors in primary angioplasty, aiming at a more effective initial reperfusion and a better sustained antithrombotic milieu, seems very attractive, particularly in association with stenting. However, the PAMI trial reported a paradoxical higher mortality in stenting patients, attributed to an observed impaired flow, compared with balloon angioplasty. Among the different molecules currently used, only abciximab has been extensively tested in patients with ST-elevation myocardial infarction.4,16,34–40
Results of randomized trials
In a recent meta-analysis of eight randomized trials conducted on abciximab as adjunctive therapy to mechanical revascularization for STEMI,41 abciximab administration was associated with a significant reduction in 30-day re-infarction, and in 30-day and 6- to 12-month mortality (Figure 2).
|
However, the benefits from adjunctive abciximab have not been uniform across studies. Several factors may explain this. In the two largest trials,4,16 patients in cardiogenic shock were excluded. This accounts for the lower-risk population in these two studies, confirmed by the low 1-month mortality rate in the control groups of the RAPPORT (4.5%) and CADILLAC (4.4%) trials. Given the advances in primary angioplasty in the last decades,42 further reductions in mortality are not easily demonstrated. Highly selected non-high-risk patients are commonly enrolled in randomized trials, whereas benefits in mortality have only been shown in trials enrolling high-risk patients.35–39 Several non-randomized studies have shown significantly better survival in patients with cardiogenic shock treated with primary angioplasty and abciximab.43,44 Future trials should focus on high-risk patients, in whom reperfusion therapies still confer unsatisfactory results.
Furthermore, in the CADILLAC trial,16 a late randomization strategy let patients receive abciximab only after the angiogram. The potential benefits of early abciximab administration are demonstrated by the better pre-procedural recanalization observed in the ADMIRAL trial,36 and the trial of Zorman et al.39 Pooled data of randomized trials comparing early vs. late abciximab administration,39,45–47 show that early abciximab administration is significantly associated with better pre-procedural TIMI flow (p = 0.001) (Figure 3).
|
The benefits of abciximab in patients treated with primary angioplasty may be related to the fact that abciximab may prevent distal embolization and improve myocardial perfusion. As reported by the Zwolle group,28 distal embolization is observed in up to 16% of patients undergoing primary angioplasty, resulting in impaired myocardial perfusion and high long-term mortality. Furthermore, the reduction in early re-infarction after abciximab may further explain the benefits in mortality observed in angioplasty trials, particularly in those enrolling patients with cardiogenic shock.
Remaining questions to be addressed
Diabetes
The impact of abciximab on mortality in diabetic patients undergoing primary angioplasty remains unclear. Attention should be focused on this high-risk population, because of the benefits in mortality shown by trials in diabetic patients undergoing elective angioplasty.48 Data from the ADMIRAL trial35 showed a significant reduction in mortality in these patients (0 vs. 16.7%). No data have been reported from the other trials.4,16,34–40
Timing of drug administration
It is still unclear whether early drug administration (at the time of diagnosis of STEMI) is more beneficial in comparison with late administration (after the angiogram). As discussed above, early abciximab administration is associated with better pre-procedural TIMI flow (Figure 3). Future, large randomized trials49,50 will clarify whether these benefits may translate in additional mortality reduction.
Dosage
Batchelor et al.51 found a decreased intensity of platelet inhibition from 4 to 12 h during abxicimab infusion, in comparison with Tirofiban and Eptifibatide. It is possible that the lower concentration of unbound abciximab is inadequate to inhibit the release of stored glycoprotein IIb-IIIa receptors during further platelet activation.52
Abciximab or small molecules in primary angioplasty?
The safety and benefits of transferring of patients for primary angioplasty53 makes the strategy of incorporating early IIb-IIIa inhibitors and half-dose thrombolytic administration during transportation (‘facilitated angioplasty’) an attractive alternative.54 This strategy may be associated with an early pre-procedural recanalization, and may compensate any delay related to transportation to tertiary centres. Furthermore, the pharmacodynamic properties of smaller molecules such as Tirofiban and Eptifibatide may be more suitable for this strategy, as the costs, and potential bleeding complications in case of urgent surgery, may be reduced. However, large randomized trials on these smaller molecules are currently lacking.
|
Conclusions |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
Compared to balloon angioplasty, routine coronary stenting does not reduce mortality and re-infarction. The benefits in target vessel revascularization seem to be reduced when applied to unselected patients with STEMI. However, direct stenting is an attractive strategy with potential benefits in terms of myocardial perfusion. Future randomized trials are needed to evaluate whether this strategy has a significant impact on outcome, and to provide a cost-benefit analysis of the unrestricted use of drug-eluting stents in this high-risk subset of patients.
Abciximab has been shown to reduce mortality in primary angioplasty, and the results of large on-going randomized trials49,50 will provide additional information. Since the feasibility of long-distance transportation has been shown in several randomized trials, early pharmacological pre-treatment may confer further advantages, by early recanalization and shorter ischaemic time, particularly in high-risk patients.55–57 Further randomized trials are needed to clarify the potential benefits from early abciximab administration and the potential role of small molecules in primary angioplasty for STEMI.
|
References |
|---|
|
TopSummaryIntroductionMethodsStenting in primary angioplastyAbciximab in primary angioplastyConclusionsReferences |
|---|
1. George BS, Voorhees WD, Roubin GS, et al. Multicenter investigation of coronary stenting to treat acute or threatened closure after percutaneous transluminal coronary angioplasty: clinical and angiographic outcomes. J Am Coll Cardiol 1993; 22:135–43.[Abstract]
2. Colombo A, Hall P, Nakamura S, et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91:1676–88.
3. Schomig A, Neumann FJ, Kastrati A, et al. A randomised comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334:1084–9.
4. Brener SJ, Barr LA, Burchenal JEB, et al. on behalf of the ReoPro and primary PTCA organization and randomised trial (RAPPORT) investigators. Randomised, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction. Circulation 1998; 98:734–41.
5. The Epistent investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet 1998; 352:87–92.[ISI][Medline]
6. Suryapranata H, van't Hof A, Hoorntje JCA, et al. Randomised comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction. Circulation 1998; 97:2502–5.
7. Suryapranata H, Ottervanger JP, Nibbering E, et al. Long term outcome and cost-effectiveness of stenting versus balloon angioplasty for acute myocardial infarction. Heart 2001; 85:667–71.
8. Antoniucci D, Santoro GM, Bolognese L, et al. A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence randomised elective stenting in acute coronary occlusion (FRESCO) trial. J Am Coll Cardiol 1998; 31:1234–9.
9. Rodriguez A, Bernardi V, Fernández M, et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Am J Cardiol 1998; 81:1286–91.[CrossRef][ISI][Medline]
10. Saito S, Hosokawa G, Tanaka S, Takamura S. Primary stent implantation is superior to balloon angioplasty in acute myocardial infarction: final results of the primary angioplasty versus stent implantation in acute myocardial infarction (PASTA) trial. PASTA Trial Investigators. Cathet Cardiovasc Interven 1999; 48:262–8.
11. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999; 341:1949–56.
12. Scheller B, Hennen N, Severin-Kneib S, et al. Follow-up of the PSAAMI study population (Primary Stenting vs Angioplasty in Acute Myocardial Infarction) (abstr). J Am Coll Cardiol 1999; 33(suppl. A):29A.
13. Kawashima A, Ueda K, Nishida I, et al. Quantitative angiographic analysis of restenosis of primary stenting using Wiktor stent for acute myocardial infarction: results from a multicenter randomised PRISAM study (abstr). Circulation 1999; 100(suppl. I):I-856.
14. Millard L, Hamon M, Khalife K, et al. A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators. J Am Coll Cardiol 2000; 35:1729–36.
15. Schwimmbeck PL, Spencker S, Hohmann C, et al. Results from the Berlin Stent Study in Acute Myocardial Infarction (abstr). Circulation 2000; 102(suppl. II):II-813.
16. Stone G, Grined CL, Cox AD, et al. for the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators. Comparison of angioplasty with stenting with or without abciximab, in acute myocardial infarction. N Engl J Med 2002; 346:957–66.
17. Stone GW, Brodie BR, Griffin JJ, et al. Clinical and angiographic follow-up after primary stenting in acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial. Circulation 1999; 99:1548–54.
18. Zhu MM, Feit A, Chadow H, Alam M, Kwam T, Clark LT. Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol 2001; 88:297–301.[CrossRef][ISI][Medline]
19. Kastrati A, Mehilli J, Nekolla S, et al. A randomized trial comparing myocardial salvage achieved by coronary stenting versus balloon angioplasty in patients with acute myocardial infarction considered ineligible for reperfusion therapy. J Am Coll Cardiol 2004; 43:734–41.
20. Schomig A, Ndrepepa G, Mehilli J, et al. Randomized trial of coronary stenting versus balloon angioplasty as a rescue intervention after failed thrombolysis in patients with acute myocardial infarction. J Am Coll Cardiol 2004; 44:2073–9.
21. Tiefenbrunn AJ, Chandra NC, French WJ, et al. Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol 1998; 31:1240–5.
22. GUSTO IIb Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997; 336:1621–8.
23. Ruygrok PN, Melkert R, Morel MA, et al. Does angiography six months after coronary intervention influence management and outcome? Benestent II Investigators. J Am Coll Cardiol 1999; 34:1507–11.
24. Suryapranata H, De Luca G, van't Hof AWJ, et al. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomized comparison in a large unselected cohort of patients. Heart 2005; 91:641–5.
25. Burzotta F, Trani C, Prati F, et al. Comparison of outcomes (early and six- month) of direct stenting with conventional stenting (a meta-analysis of ten randomized trials). Am J Cardiol 2003; 91:790–6.[CrossRef][ISI][Medline]
26. Capozzolo C, Piscione F, De Luca G, et al. Direct coronary stenting: Effects on coronary blood flow, immediate and late clinical results. Cathet Cardiovasc Interv 2001; 53:464–73.[CrossRef][ISI][Medline]
27. Rogers C, Parikh S, Seifert P, Edelman ER. Endogenous cell seeding: remnant endothelium after stenting enhances vascular repair. Circulation 1996; 94:2909–14.
28. Henriques JP, Zijlstra F, Ottervanger JP, et al. Incidence and clinical significance of distal embolisation during primary angioplasty for acute myocardial infarction. Eur Heart J 2002; 23:1112–17.
29. Loubeyre C, Morice MC, Lefèvre T, et al. A randomised comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. J Am Coll Cardiol 2002; 39:15–21.
30. Gasior M, Gierlotka A, Lekston K, et al. Randomized comparison of direct stenting and stenting after predilatation in acute myocardial infarction. In-hospital results of DIRAMI trial. Eur Heart J 2002; 23:2060.
31. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349:1315–23.
32. Stone GW, Ellis SG, Cox DA, et al. TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350:221–31.
33. Lemos PA, Saia F, Hofma SH, et al. Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction. J Am Coll Cardiol 2004; 43:704–8.
34. Neumann FJ, Blasini R, Schmitt C, et al. 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. Circulation 1998; 98:2695–701.
35. Neumann FJ, Kastrati A, Schmitt C, et al. Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction. J Am Coll Cardiol 2000; 35:915–21.
36. Montalescot G, Barragan P, Wittemberg O, et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001; 344:1895–903.
37. Petronio AS, Musumeci G, Limbruno U, et al. Abciximab improves 6-month clinical outcome after rescue coronary angioplasty. Am Heart J 2002; 143:334–41.[CrossRef][ISI][Medline]
38. Antoniucci D, Migliorini A, Parodi G, et al. Abciximab-supported infarct artery stent implantation for acute myocardial infarction and long-term survival: a prospective, multicenter, randomized trial comparing infarct artery stenting plus abciximab with stenting alone. Circulation 2004; 109:1704–6.
39. Zorman S, Zorman D, Noc M. Effects of abciximab pretreatment in patients with acute myocardial infarction undergoing primary angioplasty. Am J Cardiol 2002; 90:533–6.[CrossRef][ISI][Medline]
40. Petronio AS, Rovai D, Musumeci G, et al. Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty. Eur Heart J 2003; 24:67–76.
41. De Luca G, Suryapranata H, Stone GW, et al. Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. JAMA 2005; 193:1759–65.
42. Zijlstra F, Hoorntje JC, de Boer MJ, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341:1413–19.
43. Chan AW, Chew DP, Bhatt DL, et al. Long-term mortality benefit with the combination of stents and abciximab for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol 2002; 89:132–6.[CrossRef][ISI][Medline]
44. Antoniucci D, Valenti R, Migliorini A, et al. Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation. Am J Cardiol 2002; 90:353–7.[CrossRef][ISI][Medline]
45. Arntz H-R, Schroder JF, Pels K, et al. Prehospital versus periprocedural administration of abciximab in STEMI: early vs late results from the randomised REOMOBILE-study. Eur Heart J 2003; 24 (abstract suppl.):268.
46. Mesquita Gabriel H, Oliviera J, Canas da Silva, et al. Early administration of abciximab in the emergency room improves microperfusion after primary percutaneous coronary intervention, as assessed by the TIMI frame count: results of the ERAMI trial. Eur Heart J 2003; 24 (abstract suppl.):543.
47. Gyongyosi M, Domanovits H, Benzer W, et al. Use of abciximab prior to primary angioplasty in STEMI results in early recanalization of the infarct-related artery and improved myocardial tissue reperfusion—results of the Austrian multi-centre randomized ReoPro-BRIDGING Study. Eur Heart J 2004; 25:2125–33.
48. Marso SP, Lincoff AM, Ellis SG, et al. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: results of the EPISTENT (Evaluation of platelet IIb/IIIa inhibitor for stenting trial) diabetic substudy. Circulation 1999; 100:2477–84.
49. Di Mario C, Bolognese L, Maillard L, et al. Combined Abciximab REteplase Stent Study in acute myocardial infarction (CARESS in AMI). Am Heart J 2004; 148:378–85.[CrossRef][ISI][Medline]
50. Ellis SG, Armstrong P, Betriu A, et al. Facilitated percutaneous coronary intervention versus primary percutaneous coronary intervention: design and rationale of the Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) trial. Am Heart J 2004; 147:E16.[CrossRef][Medline]
51. Batchelor WB, Tolleson TR, Huang Y, et al. Randomized comparison of platelet inhibition with abciximab, tirofiban and eptifibatide during percutaneous coronary intervention in acute coronary syndromes: the COMPARE trial. Comparison Of Measurements of Platelet aggregation with Aggrastat, Reopro, and Eptifibatide. Circulation 2002; 106:1470–6.
52. Gawaz M, Ruf A, Pogatsa-Murray G, et al. Incomplete inhibition of platelet aggregation and glycoprotein IIb-IIIa receptor blockade by abciximab: importance of internal pool of glycoprotein IIb-IIIa receptors. Thromb Haemost 2000; 83:915–22.[ISI][Medline]
53. Dalby M, Bouzamondo A, Lechat P, Montalescot G. Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation 2003; 108:1809–14.
54. Li RH, Herrmann HC. Facilitated percutaneous coronary intervention: a novel concept in expediting and improving acute myocardial infarction care. Am Heart J 2000; 140 (6 Suppl):S125–35.
55. De Luca G, Suryapranata H, Ottervanger JP, et al. Time-delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction: Every minute delay counts. Circulation 2004; 109:1223–5.
56. De Luca G, Suryapranata H, Zijlstra F, et al. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2003; 423:991–7.
57. De Luca G, Ernst N, Zijlstra F, et al. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2004; 43:1363–7.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. De Luca, H. Suryapranata, J. Timmer, J. P. Ottervanger, A. W.J. van't Hof, J. C.A. Hoorntje, J.-H. Dambrink, A.T. M. Gosselink, and M.-J. de Boer Impact of Routine Stenting on Clinical Outcome in Diabetic Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction Diabetes Care, April 1, 2006; 29(4): 920 - 923. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||