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Abciximab therapy improves survival in patients with acute myocardial infarction complicated by early cardiogenic shock undergoing coronary artery stent implantation

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Abstract

The impact of abciximab therapy on mortality in patients with acute myocardial infarction (AMI) who are undergoing infarct-related artery (IRA) stent implantation, which is complicated by cardiogenic shock (CS) due to predominant ventricular failure has not been established, whereas concluded randomized trials comparing IRA stenting plus abciximab with IRA stenting alone in patients with AMI have produced conflicting results. Moreover, these trials have excluded patients with CS from randomization. This study sought to determine whether IRA stenting plus abciximab treatment has an impact on 1-month mortality compared with IRA stenting alone in consecutive patients with AMI complicated by CS due to predominant ventricular failure. Of 77 patients with CS and IRA stenting, 44 had abciximab therapy, whereas 33 underwent primary IRA stenting alone. There were no differences between groups in major baseline characteristics except for a higher incidence of women in the stent alone group compared with the abciximab group (36% vs 14%, p = 0.020). The 1-month overall mortality rate was 18% in the abciximab group and 42% in the stent alone group (p <0.020). There were no differences between groups in reinfarction and target vessel revascularization rates. Multivariate analysis showed that abciximab therapy was the only variable that was independently related to 1-month mortality (odds ratio 0.36; 95% confidence intervals 0.15 to 0.86, p = 0.021). The results of this study support the use of abciximab in patients with AMI complicated by CS who are undergoing IRA stent implantation. The mechanism of the clinical benefit of abciximab at 1 month was not related to the patency of the IRA.

Section snippets

Study patient cohort

The study included consecutive patients with AMI complicated by CS who underwent IRA stenting between January 1999 and July 2001. CS due to predominant ventricular failure was defined as systolic blood pressure <90 mm Hg (without inotropic or intra-aortic balloon support) associated with signs of end-organ hypoperfusion, such as cold or diaphoretic extremities, altered mental status, or anuria. The diagnosis of CS due to predominant ventricular failure was confirmed by cardiac catheterization

Study cohort, and procedural and clinical outcomes

Between January 1999 and July 2001, 739 patients with AMI underwent percutaneous mechanical intervention. Of these, 84 patients (11%) had CS due to predominant ventricular failure. Three patients had 3 primary failures (4%), whereas 4 patients (5%), all with a IRA diameter <2.5 mm, had successful coronary angioplasty without stent implantation. The remaining 77 patients with successful IRA stenting were considered for analysis. Abciximab therapy was administered to 44 patients (57%), whereas

Abciximab and IRA stenting for AMI complicated by CS

Previous randomized studies comparing abciximab therapy as an adjunct to IRA stenting with IRA stenting alone in patients without CS have produced conflicting results. The Abciximab before Direct angioplasty and stenting in Myocardial Infarction Regarding Acute and Long term follow-up (ADMIRAL) trial and the Intracoronary Stenting and Antithrombotic Regimen (ISAR-2) trial have demonstrated a benefit of abciximab therapy as an adjunct to IRA stent implantation in terms of reduction of the

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This study was supported by the A.R. Cardiology ONLUS Foundation, Florence, Italy.

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