Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction: Observations from the TIMI 14 trial

James A de Lemos, Elliott M. Antman, C. Michael Gibson, Carolyn H. McCabe, Robert P. Giugliano, Sabina A. Murphy, Stephanie A. Coulter, Keaven Anderson, Joel Scherer, Martin J. Frey, R. Van Der Wieken, Frans Van De Werf, Eugene Braunwald

Research output: Contribution to journalArticle

258 Scopus citations

Abstract

Background - In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation. Methods and Results - All 346 patients with interpretable baseline and 90-minute ECGs, treated with either tPA alone or abciximab plus reduced- dose tPA (combination therapy), were included. Patients receiving combination therapy (n=221) had a 59% rate of complete (≥70%) ST resolution at 90 minutes versus 37% in those treated with tPA alone (n=125) (P<0.0001). When the analysis was limited to patients with TIMI 3 flow, patients treated with combination therapy (n=151) remained significantly more likely to achieve complete ST resolution than those receiving tPA alone (n=80) (69% versus 44%; P=0.0002). Conclusions - Combination therapy with abciximab and reduced-dose tPA improves myocardial (microvascular) reperfusion, as reflected in greater ST-segment resolution, in addition to epicardial flow. This finding may translate into improved clinical outcomes by enhancing myocardial salvage.

Original languageEnglish (US)
Pages (from-to)239-243
Number of pages5
JournalCirculation
Volume101
Issue number3
DOIs
StatePublished - Jan 25 2000

Keywords

  • Electrocardiography
  • Microcirculation
  • Myocardial infarction
  • Reperfusion
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    de Lemos, J. A., Antman, E. M., Gibson, C. M., McCabe, C. H., Giugliano, R. P., Murphy, S. A., Coulter, S. A., Anderson, K., Scherer, J., Frey, M. J., Van Der Wieken, R., Van De Werf, F., & Braunwald, E. (2000). Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction: Observations from the TIMI 14 trial. Circulation, 101(3), 239-243. https://doi.org/10.1161/01.CIR.101.3.239