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Efficacy of Combination Treatment with Intracoronary Abciximab and Aspiration Thrombectomy on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Stenting

유병수|이승환|이지현|윤정한|이준원|윤영진|안민수|최경훈|탁승제|김장영|안성균
연세대학교의과대학 (Yonsei University College of Medicine)|2014.05|Yonsei Medical Journal|제55권 제3호|pp. 606-616|DOI 10.3349/ymj.2014.55.3.606

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myocardial infarctionAbciximabthrombosuctionmyocardial perfusion
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초록

Purpose: We aimed to investigate whether combination therapy using intracoronary(IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusioncompared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: We enrolled 40 patients with STEMI, who presentedwithin 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. Results:IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximabgroup (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). Conclusion: Combination treatment using IC abciximab and AT may synergisticallyimprove myocardial perfusion in patients with STEMI undergoing primaryPCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).

Abstract

Purpose: We aimed to investigate whether combination therapy using intracoronary(IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusioncompared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: We enrolled 40 patients with STEMI, who presentedwithin 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. Results:IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximabgroup (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). Conclusion: Combination treatment using IC abciximab and AT may synergisticallyimprove myocardial perfusion in patients with STEMI undergoing primaryPCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).

참고문헌 (42)

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