PMID- 22059390
OWN - NLM
STAT- MEDLINE
DCOM- 20120703
LR  - 20181201
IS  - 1540-8183 (Electronic)
IS  - 0896-4327 (Linking)
VI  - 25
IP  - 1
DP  - 2012 Feb
TI  - Aspiration thrombectomy during primary percutaneous coronary intervention as 
      adjunctive therapy to early (in-ambulance) abciximab administration in patients 
      with acute ST elevation myocardial infarction: an analysis from Leiden MISSION! 
      acute myocardial infarction treatment optimization program.
PG  - 1-9
LID - 10.1111/j.1540-8183.2011.00686.x [doi]
AB  - BACKGROUND: The benefits of early abciximab administration and thrombus 
      aspiration in ST elevation myocardial infarction (STEMI) patients undergoing 
      primary percutaneous coronary intervention (PPCI) have previously been 
      elaborated. However, whether there is an adjunctive effect of thrombus aspiration 
      among STEMI patients, with angiographic evidence of thrombus, receiving early 
      prehospital abciximab remains unclear. METHODS:  In the context of a fixed 
      protocol for PPCI, 158 consecutive patients with STEMI were enrolled, in whom 
      abciximab was started early before hospital arrival (in-ambulance); 79 patients 
      who had PPCI with thrombus aspiration (thrombectomy-facilitated PCI group), were 
      compared to 79 who had PPCI without thrombus aspiration (conventional PCI group) 
      in a prospective nonrandomized study. The primary end-point was complete 
      ST-segment resolution within 90 minutes. Secondary end points included distal 
      embolization, enzymatic infarct size as well as left ventricular ejection 
      fraction (LVEF) assessed by gated single-photon emission computed tomography. 
      Major adverse cardiac events (MACEs) were evaluated up to 12 months. RESULTS: 
       Both groups were comparable for baseline characteristics. ST-segment resolution 
      was significantly higher in the thrombectomy-facilitated group (P = 0.002), and 
      multivariate analysis identified thrombectomy as an independent predictor of 
      ST-segment resolution (OR = 9.4, 95% CI = 2.6-33.5, P = 0.001). Distal 
      embolization was higher in the conventional PCI group among patients with higher 
      thrombus grades. No difference was observed between both groups in infarct size 
      assessed by peak creatine kinase (p = 0.689) and peak Tn-T levels (P = 0.435). 
      Also, the LVEF at 3 months was similar (P = 0.957). At 12 month clinical 
      follow-up, thrombus aspiration was, however, associated with reduced all-cause 
      mortality (log-rank p = 0.032). CONCLUSION:  Among STEMI patients treated with 
      PPCI and in-ambulance abciximab, it appears that a selective strategy of thrombus 
      aspiration still has additive benefit.
CI  - (c) 2012, Wiley Periodicals, Inc.
FAU - Ahmed, Tarek A N
AU  - Ahmed TA
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Atary, Jael Z
AU  - Atary JZ
FAU - Wolterbeek, Ron
AU  - Wolterbeek R
FAU - Hasan-Ali, Hosam
AU  - Hasan-Ali H
FAU - Abdel-Kader, Samir S
AU  - Abdel-Kader SS
FAU - Schalij, Martin J
AU  - Schalij MJ
FAU - Jukema, J Wouter
AU  - Jukema JW
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111108
PL  - United States
TA  - J Interv Cardiol
JT  - Journal of interventional cardiology
JID - 8907826
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Anticoagulants)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - X85G7936GV (Abciximab)
SB  - IM
MH  - Abciximab
MH  - Aged
MH  - Ambulances
MH  - Antibodies, Monoclonal/administration & dosage/*therapeutic use
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - *Cardiac Catheterization/methods
MH  - Electrocardiography
MH  - Emergency Medicine/methods
MH  - Female
MH  - Humans
MH  - Immunoglobulin Fab Fragments/administration & dosage/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/drug therapy/*therapy
MH  - Netherlands
MH  - Prospective Studies
MH  - Stents
MH  - Survival Analysis
MH  - *Thrombectomy
MH  - Treatment Outcome
EDAT- 2011/11/09 06:00
MHDA- 2012/07/04 06:00
CRDT- 2011/11/09 06:00
PHST- 2011/11/09 06:00 [entrez]
PHST- 2011/11/09 06:00 [pubmed]
PHST- 2012/07/04 06:00 [medline]
AID - 10.1111/j.1540-8183.2011.00686.x [doi]
PST - ppublish
SO  - J Interv Cardiol. 2012 Feb;25(1):1-9. doi: 10.1111/j.1540-8183.2011.00686.x. Epub 
      2011 Nov 8.