Cardiovascular Pharmacology: Open Access

Abstract

Mortality Reduction with Administration of Abciximab during Primary PCI is Confined to STEMI Patients with Complex Lesions

Allan Zeeberg Iversen, Soren Galatius, Sune Pedersen, Ulrik Abildgaard and Jan Skov Jensen

Aim: The optimal timing of abciximab administration (´up-stream´/´in-cath-lab´) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unclear. Data suggest that patients with high-risk profiles benefit from abciximab the most. Complex lesion on coronary angiography (CAG) implies a high-risk profile. Thus, we aimed to investigate whether lesion type (complex/simple) predicted the effect of abciximab in STEMI-patients undergoing pPCI.

Methods and results: 2,935 STEMI-patients treated with pPCI were retrospectively stratified according to lesion type on CAG (complex/simple) and use of abciximab. Endpoints at 1 year were mortality, target vessel revascularization (TVR), myocardial infarction (MI), and the combination of these. Forty-seven percent had a complex lesion on CAG. Among those, abciximab reduced one-year mortality in both the univariate (from 12.7% to 7.8%, p=0.006) and the adjusted analysis (HR 0.62, CI 0.42-0.91, p=0.015). Patients with simple lesions had no mortality benefit of abciximab. Effect of abciximab on TVR or MI was neutral. Regarding the combined endpoint, abciximab treatment conferred a risk reduction in patients with complex lesions.

Conclusion: Benefit of abciximab in STEMI-patients undergoing PCI was confined to those with complex lesions on CAG. Consequently, early abciximab treatment without knowledge of the lesion type may not be recommended.