NEW YORK (Reuters Health) – Giving abciximab to high-risk patients with ST-elevation myocardial infarction (STEMI) before transferring them for percutaneous coronary intervention (PCI) reduces 1-year mortality without increasing bleeding complications, new research shows.

This finding, reported in the American Heart Journal for October, is based on European registry data for 1,086 STEMI patients referred for primary PCI.

In 727 patients, abciximab was administered early (i.e., before admission to the catheterization lab, at least 30 minutes before first balloon inflation or coronary angiography). In 359 patients, the drug was administered late (i.e., immediately before or during PCI).

A total of 616 patients (56.7%) with a TIMI score of 3 or greater made up the high risk group, and the remaining 470 patients formed the low-risk cohort. Factoring in the timing of abciximab administration resulted in four patient groups who were compared for mortality at 1 year: early administration/high-risk (n = 413); late administration/high-risk (n = 203); early administration/low-risk (n = 314); and late administration/low-risk (n = 156).

Regardless of risk profile, the final angiographic PCI result (TIMI flow grade 3 rate) was better in patients receiving early abciximab.

Lead author Dr. Tomasz Rakowski, from Jagiellonian University Medical Center, Krakow, Poland and his colleagues also found that the odds of death at 1 year were significantly lower in the early abciximab/high-risk group compared to the late administration/high-risk group (8.7% vs 15.8%; p = 0.01, OR 0.51).

In a multivariate Cox model, both early abciximab administration and TIMI score 3 or greater emerged as independent predictors of 1-year mortality.

Regardless of risk profile, early administration of abciximab did not increase rates of bleeding complications, the investigators found.

These findings, Dr. Rakowski and colleagues point out, support recent American College of Cardiology/American Heart Association STEMI guidelines, “which recommend that the strategy of early abciximab administration may be indicated for high-risk STEMI patients (who present) early with acceptable bleeding risk profile.”

Reference:
Am Heart J 2009;158:569-575.