Early abciximab administration before transfer for primary percutaneous coronary interventions for ST-elevation myocardial infarction reduces 1-year mortality in patients with high-risk profile. Results from EUROTRANSFER Registry

Rakowski, Tomasz; Siudak, Zbigniew; Dziewierz, Artur; Birkemeyer, Ralf; Legutko, Jacek; Mielecki, Waldemar; Depukat, Rafal; Janzon, Magnus; Stefaniak, Justyna; Zmudka, Krzysztof; Dubiel, Jacek S.; Partyka, Lukasz; Dudek, Dariusz

doi:10.1016/j.ahj.2009.08.008

« Previous Next »American Heart Journal
Volume 158, Issue 4 , Pages 569-575, October 2009

Early abciximab administration before transfer for primary percutaneous coronary interventions for ST-elevation myocardial infarction reduces 1-year mortality in patients with high-risk profile. Results from EUROTRANSFER Registry

Tomasz Rakowski, MD, PhD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Zbigniew Siudak, MD, PhD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Artur Dziewierz, MD, PhD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Ralf Birkemeyer, MD
- Department of Cardiology, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Germany
Jacek Legutko, MD, PhD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Waldemar Mielecki, MD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Rafal Depukat, MD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Magnus Janzon, MD, PhD
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
Justyna Stefaniak, MSc
- Krakow Cardiovascular Research Institute, Krakow, Poland
Krzysztof Zmudka, MD, PhD
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
Jacek S. Dubiel, MD, PhD
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Lukasz Partyka, MD, PhD
- Krakow Cardiovascular Research Institute, Krakow, Poland
Dariusz Dudek, MD, PhD
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Reprint requests: Dariusz Dudek, MD, PhD, Department of Interventional Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland.

Received 2 June 2009; accepted 13 August 2009.

Background

There are conflicting data on the clinical benefit from early administration of abciximab from a large randomized trial and a registry. However, both sources suggest that a benefit may depend on the baseline risk profile of the patients. We evaluated the role of early abciximab administration in patients with ST-segment-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention stratified by the STEMI Thrombolysis In Myocardial Infarction (TIMI) risk score.

Methods

A total of 1,650 patients were enrolled into the EUROTRANSFER Registry. One thousand eighty-six patients received abciximab (66%). Abciximab was administered early in 727 patients (EA) and late in 359 patients (LA). We used the TIMI risk score for risk stratification. Patients with scores ≥3 constituted the high-risk group of 616 patients (56.7%), whereas 470 patients formed the low-risk cohort. Factoring in the timing of the abciximab administration resulted in 4 groups of patients who were compared for mortality at 1 year: EA/high-risk (n = 413); LA/high-risk (n = 203); EA/low-risk (n = 314); LA/low-risk (n = 156). Baseline difference was accounted for by means of propensity score.

Results

In high-risk patients, 1-year mortality was significantly lower with early abcximab compared to late administration (8.7% vs 15.8%; odds ratio 0.51, CI 0.31-0.85, P = .01). In multivariable Cox regression analysis, both early abciximab administration and patients' risk profile (TIMI score ≥3) were identified as independent predictors of 1-year mortality.

Conclusions

Early abciximab administration before transfer for percutaneous coronary intervention in STEMI shows lower mortality at 1-year follow-up. This effect is confined to patients with higher risk profile as defined by TIMI risk score ≥3.