Facilitated PCI in patients with ST-elevation myocardial infarction

被引:471
作者
Ellis, Stephen G. [1 ]
Tendera, Michal [2 ]
de Belder, Mark A. [3 ]
van Boven, Ad J. [4 ]
Widimsky, Petr [5 ,6 ]
Janssens, Luc [7 ]
Andersen, H. R. [8 ]
Betriu, Amadeo [9 ]
Savonitto, Stefano [10 ]
Adamus, Jerzy [11 ]
Peruga, Jan Z. [12 ]
Kosmider, Maciej [13 ]
Katz, Olivier [14 ]
Neunteufl, Thomas [15 ]
Jorgova, Julia [16 ]
Dorobantu, Maria [17 ]
Grinfeld, Liliana [18 ]
Armstrong, Paul [19 ]
Brodie, Bruce R. [20 ]
Herrmann, Howard C. [21 ]
Montalescot, Gilles [22 ]
Neumann, Franz-Josef [23 ]
Effron, Mark B. [24 ]
Barnathan, Elliot S. [25 ]
Topol, Eric J. [26 ,27 ]
机构
[1] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44195 USA
[2] Med Univ Silesia, Katowice, Poland
[3] James Cook Univ Hosp, Middlesbrough, Cleveland, England
[4] Med Centrum Leeuwarden, Leeuwarden, Netherlands
[5] Charles Univ Prague, Prague, Czech Republic
[6] Univ Hosp Kralovske Vinohrady, Prague, Czech Republic
[7] AZ Imelda Ziekenhuis, Bonheiden, Belgium
[8] Skejby Univ Hosp, Aarhus N, Denmark
[9] Hosp Clin Barcelona, Barcelona, Spain
[10] Osped Niguarda Ca Granda, Milan, Italy
[11] Centralny Szpital Klin WAM, Warsaw, Poland
[12] Uniwersytet Medycznego, Katedra 2, Klin Kardiol 1, Lodz, Poland
[13] SP ZOZ Szpital Klin 3, Lodz, Poland
[14] Clin St Joseph, Colmar, France
[15] Allgemeines Krankenhaus Wien, Vienna, Austria
[16] UMHAT St George, Plovdiv, Bulgaria
[17] Emergency Hosp Floreasca, Bucharest, Romania
[18] Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina
[19] Univ Alberta Hosp, Edmonton, AB T6G 2B7, Canada
[20] LeBauer Cardiovasc Res, Greensboro, NC USA
[21] Univ Penn, Med Ctr, Philadelphia, PA 19104 USA
[22] Hop La Pitie Salpetriere, Paris, France
[23] Herz Zentrum Bad Krozingen, Bad Krozingen, Germany
[24] Eli Lilly & Co, Indianapolis, IN 46285 USA
[25] Centocor Inc, Res & Dev, Malvern, PA 19355 USA
[26] Scripps Res Inst, La Jolla, CA USA
[27] Scripps Clin, La Jolla, CA USA
关键词
D O I
10.1056/NEJMoa0706816
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background We hypothesized that percutaneous coronary intervention (PCI) preceded by early treatment with abciximab plus half-dose reteplase (combination-facilitated PCI) or with abciximab alone (abciximab-facilitated PCI) would improve outcomes in patients with acute ST-segment elevation myocardial infarction, as compared with abciximab administered immediately before the procedure (primary PCI). Methods In this international, double-blind, placebo-controlled study, we randomly assigned patients with ST-segment elevation myocardial infarction who presented 6 hours or less after the onset of symptoms to receive combination-facilitated PCI, abciximab-facilitated PCI, or primary PCI. All patients received unfractionated heparin or enoxaparin before PCI and a 12-hour infusion of abciximab after PCI. The primary end point was the composite of death from all causes, ventricular fibrillation occurring more than 48 hours after randomization, cardiogenic shock, and congestive heart failure during the first 90 days after randomization. Results A total of 2452 patients were randomly assigned to a treatment group. Significantly more patients had early ST-segment resolution with combination-facilitated PCI (43.9%) than with abciximab-facilitated PCI (33.1%) or primary PCI (31.0%; P = 0.01 and P = 0.003, respectively). The primary end point occurred in 9.8%, 10.5%, and 10.7% of the patients in the combination-facilitated PCI group, abciximab-facilitated PCI group, and primary-PCI group, respectively (P = 0.55); 90-day mortality rates were 5.2%, 5.5%, and 4.5%, respectively (P = 0.49). Conclusions Neither facilitation of PCI with reteplase plus abciximab nor facilitation with abciximab alone significantly improved the clinical outcomes, as compared with abciximab given at the time of PCI, in patients with ST-segment elevation myocardial infarction.
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收藏
页码:2205 / 2217
页数:13
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