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

Dudek, Dariusz; Siudak, Zbigniew; Janzon, Magnus; Birkemeyer, Ralf; Aldama-Lopez, Guillermo; Lettieri, Corrado; Janus, Bogdan; Wisniewski, Andrzej; Berti, Sergio; Olivari, Zoran; Rakowski, Tomasz; Partyka, Lukasz; Goedicke, Jochen; Zmudka, Krzysztof; on behalf of EUROTRANSFER Registry investigators,

doi:10.1016/j.ahj.2008.08.004

« Previous Next »American Heart Journal
Volume 156, Issue 6 , Pages 1147-1154, December 2008

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

Dariusz Dudek, MD, PhD, FESC
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Reprint requests: Dariusz Dudek, MD, PhD, FESC, Department of Interventional Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland.
Zbigniew Siudak, MD
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
Magnus Janzon, MD, PhD
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
Ralf Birkemeyer, MD
- Department of Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
Guillermo Aldama-Lopez, MD
- Department of Cardiology, Hospital Juan Canalejo, Coruna, Spain
Corrado Lettieri, MD
- Interventional Cardiology Department, Ospedale Carlo Poma, Mantova, Italy
Bogdan Janus, MD
- Department of Interventional Cardiology, Specjalistyczny Szpital im. E. Szczeklika, Tarnow, Poland
Andrzej Wisniewski, MD
- Department of Cardiology, Przemysl, Poland
Sergio Berti, MD
- Department of Interventional Cardiology, Ospedale G. Pasquinucci, Massa, Italy
Zoran Olivari, MD
- Ospedale S. Maria di Ca'Foncello, Treviso, Italy
Tomasz Rakowski, MD, PhD
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
Lukasz Partyka, MD, PhD
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
Jochen Goedicke, MD
- Eli Lilly Critical Care Europe, Geneva, Switzerland
Krzysztof Zmudka, MD, PhD
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
on behalf of EUROTRANSFER Registry investigators

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.