European registry on patients with ST-elevation myocardial infarction transferred for mechanical reperfusion with a special focus on early administration of abciximab—EUROTRANSFER Registry

Received 29 January 2008; accepted 3 August 2008. published online 20 October 2008.

Background

Abciximab is established as adjunct to primary percutaneous coronary intervention (PCI). Based on some smaller studies, ST-segment elevation myocardial infarction (STEMI) networks in various European countries have adopted the start of abciximab before transfer to the catheterization laboratory (cathlab) hospital as part of their routine treatment options. Although a recently published study did not reveal improved clinical outcome when starting abciximab before the cathlab, a potential benefit from such early administration, in particular in the setting of transfer networks, remains unclear and has been the subject of debate.

Methods

Data of consecutive patients with STEMI transferred for primary PCI in hospital/ambulance-feeded STEMI networks treated between November 2005 and January 2007 at 15 PCI centers from 7 European countries were collected in the web-based EUROTRANSFER Registry.

Results

Data from a total of 1,650 patients were collected. Abciximab was administered to 1086 patients (66%), of whom 727 received early abciximab (EA group: abciximab started before admission to cathlab, at least 30 minutes before balloon). Another 359 patients received late abciximab (LA group: periprocedural administration of abciximab in the cathlab). Preprocedural TIMI 3 flow was observed in 17.7% of patients with EA and in 8.9% in the LA group (P < .0001). Thirty-day mortality was 3.9% in the EA group versus 7.5% with LA (OR 0.49, 95% CI 0.29-0.85, P = .011), and composite 30-day outcome including death, repeated myocardial infarction, and urgent revascularization was present in 5.5% and 10.3%, respectively (OR 0.51, 95% CI 0.32-0.81, P = .004). These differences remain statistically significant in favor of early abciximab after accounting and adjustment for differences between the groups by means of a multivariate regression model and propensity score.

Conclusions

Patients in STEMI networks transferred for primary PCI who have received abciximab before transfer rather than in the cathlab had more patent arteries before PCI and showed lower rates for death and the composite clinical outcome at 30-day follow-up.

a Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland

b Department of Cardiology, Linköping University Hospital, Linköping, Sweden

c Department of Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany

d Department of Cardiology, Hospital Juan Canalejo, Coruna, Spain

e Interventional Cardiology Department, Ospedale Carlo Poma, Mantova, Italy

f Department of Interventional Cardiology, Specjalistyczny Szpital im. E. Szczeklika, Tarnow, Poland

g Department of Cardiology, Przemysl, Poland

h Department of Interventional Cardiology, Ospedale G. Pasquinucci, Massa, Italy

i Ospedale S. Maria di Ca'Foncello, Treviso, Italy

j Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland

k Eli Lilly Critical Care Europe, Geneva, Switzerland

Reprint requests: Dariusz Dudek, MD, PhD, FESC, Department of Interventional Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland.

ClinicalTrials.gov identifier: NCT00378391.

Author disclosure statements can be found in Appendix A.

PII: S0002-8703(08)00661-3

doi:10.1016/j.ahj.2008.08.004

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