Mortality Reduction with Administration of Abciximab during Primary PCI is Confined to STEMI Patients with Complex Lesions

Allan Zeeberg Iversen, Sore

Abstract

Aim: The optimal timing of abciximab administration (´up-stream´/´in-cath-lab´) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is unclear. Data suggest that patients with high-risk profiles benefit from abciximab the most. Complex lesion on coronary angiography (CAG) implies a high-risk profile. Thus, we aimed to investigate whether lesion type (complex/simple) predicted the effect of abciximab in STEMI-patients undergoing pPCI.\r\n\r\nMethods and results: 2,935 STEMI-patients treated with pPCI were retrospectively stratified according to lesion type on CAG (complex/simple) and use of abciximab. Endpoints at 1 year were mortality, target vessel revascularization (TVR), myocardial infarction (MI), and the combination of these. Forty-seven percent had a complex lesion on CAG. Among those, abciximab reduced one-year mortality in both the univariate (from 12.7% to 7.8%, p=0.006) and the adjusted analysis (HR 0.62, CI 0.42-0.91, p=0.015). Patients with simple lesions had no mortality benefit of abciximab. Effect of abciximab on TVR or MI was neutral. Regarding the combined endpoint, abciximab treatment conferred a risk reduction in patients with complex lesions.\r\n\r\nConclusion: Benefit of abciximab in STEMI-patients undergoing PCI was confined to those with complex lesions on CAG. Consequently, early abciximab treatment without knowledge of the lesion type may not be recommended.\r\n