Introduction: Successful reperfusion at the epicardial level is not always accompanied by reperfusion of the microvasculature. Therapies targeted against 'no-flow' are often employed in patients receiving primary percutaneous coronary intervention (pPCI) after acute myocardial infarction.
Hypothesis: Abciximab as adjunctive to pPCI will improve ST-segment resolution used as a surrogate for optimal microvascular reperfusion, and improve prognosis.
Methods: In the DANAMI-2 trial 309/790 (39%) patients treated with pPCI received abciximab at physician discretion. SigmaST-segment elevation at baseline, 90 min, 4 h, 12 h, 24 h after pPCI and at discharge was measured and ST-segment resolution grouped as: Complete (> or = 70 %); Partial (> or = 30 to < 70%); No (< 30%). Clinical endpoints were death, re-infarction and disabling stroke.
Results: Abciximab prescription varied from 24.4-60.3% in the different hospitals. Patients receiving abciximab had a higher risk profile. ST-segment resolution at 90 min and 24 h was identical in the two groups, but at 4 h and 12 h partial ST-segment resolution was more pronounced in patients receiving abciximab (P = 0.001, P = 0.026). In a multivariate analysis, adjusting for baseline differences abciximab was associated with improved partial ST-segment resolution at 12 h. Patients treated with abciximab had no re-infarction at 30 days (0% versus 2.8%, P = 0.003), but increased disabling stroke rate (2.3% versus 0.4%; P = 0.019) driven by cerebral infarctions, and not intracranial hemorrhage. There were no differences in death rates.
Conclusions: In the DANAMI-2 trial with no age limit, the decreased re-infarction rates in patients receiving abciximab was offset by increased disabling stroke rates. Abciximab in conjunction with pPCI is associated with more pronounced partial ST-segment resolution after 4 h to 12 h suggesting improved microvascular reperfusion.