Stenting and fibrinolysis
Stenting plus abciximab gives better clinical outcome than thrombolysis after acute MI.
LONDON, August 11 (SPIS MedWire) In patients with acute myocardial infarction, coronary stenting plus abciximab results in a greater degree of myocardial salvage than fibrinolysis with alteplase, according to a report in the New England Journal of Medicine. Schomig and colleagues at Deutsches Herzzentrum, Munich, studied 140 patients with AMI who were randomly assigned to receive either a stent plus blockade of platelet glycoprotein IIb/IIIa receptors with abciximab (Reopro) or accelerated infusion of alteplase (Actilyse), a tissue plasminogen activator. In the stent plus abciximab group, the median size of the final infarct was 14.3% of the left ventricle, compared with 19.4% in the alteplase group. The authors say the difference was due to a larger salvage index — that is, the percentage of the left ventricle that was salvaged divided by the percentage that was compromised by the initial perfusion defect — in the stent group. The combined incidence of death, reinfarction and stroke at six months was 8.5% in the stent group and 23.2% in the alteplase group. The team was unable to quantify the proportion of benefit that was due to stenting and that which was due to abciximab. However, they note that "abciximab may have contributed importantly to our results because the extent of benefit appears to be greater than observed in prior comparisons of tissue plasminogen activator with percutaneous coronary interventions without the adjunctive use of platelet glycoprotein IIb/IIIa blockage for MI." The team also note that, in light of the recently-published TIMI 14 results, "further studies are needed to test whether this combined regimen also leads to a greater degree of myocardial salvage than fibrinolytic therapy alone."