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QJM Advance Access published online on July 22, 2005
QJM, doi:10.1093/qjmed/hci097
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Review

Coronary stenting and abciximab in primary angioplasty for ST-segment-elevation myocardial infarction

G. De Luca 1, H. Suryapranata 2*, R. Grimaldi 2, and M. Chiariello 3

1 From the Division of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands; Division of Cardiology, ‘Federico II’ University, Naples, Italy
2 From the Division of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands
3 From the Division of Cardiology, ‘Federico II’ University, Naples, Italy

* To whom correspondence should be addressed.
H. Suryapranata, E-mail: h.suryapranata{at}diagram-zwolle.nl


  Abstract

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.


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