Effect of abciximab on the pattern of reperfusion in patients with acute myocardial infarction treated with primary angioplasty

Timely reperfusion therapy in acute myocardial infarction limits infarct size and improves survival.(1) Compared with fibrinolytic therapy, primary angioplasty achieves Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in a higher proportion of patients and is associated with improved early outcome.(2) Despite superior ability to relieve epicardial artery stenosis, mechanical revascularization is frequently associated with embolization of plaque and platelet thrombus to the distal capillary bed, which may result in a no-reflow phenomenon similar to that observed with fibrinolysis.(3) Because platelet IIb/IIIa receptor blockade with abciximab has been shown to reduce the incidence of acute ischemic events after coronary angioplasty, the combination of primary angioplasty and platelet integrin inhibition has been tested in the ReoPro And Primary PTCA Organization and Randomized Trial (RAPPORT).(4) In patients undergoing angioplasty and receiving abciximab, the 7-day incidence of reinfarction and urgent reintervention was reduced by 76% (p = 0.06) and 79% (p = 0.008), respectively, when compared with placebo. It is not known whether abciximab affected infarct size or the speed of reperfusion WP investigated whether the platelet inhibition afforded by abciximab altered the pattern of reperfusion in patients undergoing primary angioplasty with respect to peak creatine kinase (CK) release, infarct size expressed as area-under-the-curve (AUC), and time-to-peak CK.