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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
AFRICA
45
Intracoronary or intravenous abciximab after aspiration
thrombectomy in patients with STEMI undergoing
primary percutaneous coronary intervention
Ali Bedjaoui, Karima Allal, Mohamed Sofiane Lounes, Chams Eddine Belhadi, Abdelmoumen
Mekarnia, Saber Sediki, Maamar Kara, Adel Azaza, Jean-Jacques Monsuez, Salim Benkhedda
Abstract
Objectives:
To test whether aspiration thrombectomy with
intracoronary (IC) instead of intravenous (IV) administra-
tion of abciximab could reduce the no-reflow phenomenon in
patients undergoing primary percutaneous intervention (PCI)
for ST-elevation myocardial infarction (STEMI).
Background:
Despite recanalisation with PCI, failure to restore
microvascular flow may affect the prognosis of patients with
STEMI. A combination of aspiration thrombectomy with IC
abciximab may improve distal perfusion.
Methods:
After aspiration thrombectomy during primary PCI
for STEMI, 160 patients were randomly assigned to either an
IV or IC abciximab bolus delivered through the aspiration
catheter, both followed by a 12-hour IV abciximab infusion.
Results:
ST-segment resolution
≥
70% was achieved in 36 of
78 patients with IC versus 30 of 82 patients with IV abciximab
(46.1 vs 36.6%,
p
=
0.368), and partial resolution in 28 of 78
versus 31 of 82 patients (35.9 vs 37.8%,
p
=
0.368). Post-
procedural myocardial blush grade (MBG) 3 was obtained in
62.8 vs 63.4% (
p
=
0.235) and MBG
≥
2 in 89.7 vs 81.7% (
p
=
0.148) of patients given IC and IV abciximab, respectively.
There were three deaths in each group (3.8%). Major adverse
cardiac events occurred in six of 78 patients given the IC and
seven of 82 patients given the IV abciximab bolus (7.6 vs
8.5%,
p
=
0.410). One stroke occurred in each group, and two
patients in the IC and nine in the IV group developed renal
failure (2.5 vs 10.9 %,
p
=
0.414).
Conclusion:
IC versus IV abciximab did not enhance myocar-
dial reperfusion in non-selected patients with STEMI under-
going primary PCI after aspiration thrombectomy had
successfully been performed.
Keywords:
myocardial infarction, primary percutaneous inter-
vention, aspiration thrombectomy, abciximab
Submitted 25/5/18, accepted 31/10/18
Published online 20/11/18
Cardiovasc J Afr
2019;
30
: 45–51
www.cvja.co.zaDOI: 10.5830/CVJA-2018-063
Rapid and sustained restoration of a thrombolysis in myocardial
infarction (TIMI) 3 anterograde flow through the epicardial
coronary artery, associated with a resolution of ST-segment
elevation
>
70% within 90 minutes are the primary goals of the
current treatment of ST-segment elevation myocardial infarction
(STEMI).
1-3
Despite mechanical recanalisation of the occluded
artery with primary percutaneous coronary intervention (PCI)
and aggressive antithrombotic therapy directed at preventing
thrombus growth and mitigating distal embolisation, these goals
are not reached in many instances.
A major limitation of primary PCI is the possibility of
distal embolisation of thrombus and failure to restore flow at
the microvascular level. ST-segment elevation persists in more
than 40% of cases of patients in whom a TIMI 3 flow has
been achieved by primary PCI, a drawback associated with
subsequent impairment of left ventricular (LV) function and a
worse prognosis.
4-6
Over the past decade, several approaches have been directed
to prevent or reverse the no-reflow phenomenon, including
aspiration thrombectomy
7-11
and intracoronary glycoprotein IIb/
IIIa inhibitor administration, such as abciximab.
12-17
Abciximab,
the Fab fragment of the chimeric human–murine monoclonal
antibody 7E3, binds to the glycoprotein IIb/IIIa receptor of
human platelets and inhibits platelet aggregation. However,
randomised trials of both thrombus aspiration and intracoronary
(IC) versus intravenous (IV) abciximab administration have
shown inconsistent results of these adjunctive methods with
regard to clinical outcomes as well as to surrogate reperfusion
parameters.
In addition, these two approaches have been compared to
each other in the INFUSE-AMI study, in which intralesional
abciximab was delivered through a dedicated infusion
catheter consisting of a microporous balloon (ClearWay RX).
Cardiology Oncology Research Collaborative Group
(CORCG), Faculty of Medicine, Benyoucef Benkhedda
University, Algiers, Algeria
Ali Bedjaoui, MD
Salim Benkhedda, MD, PhD
Department of Cardiology, Hôpital Central de l’Armée Ain
Naadja, Algiers, Algeria
Ali Bedjaoui, MD
Karima Allal, MD
Mohamed Sofiane Lounes, MD
Chams Eddine Belhadi, MD
Abdelmoumen Mekarnia, MD
Department of Cardiology, Mustapha University Hospital
Centre, Algiers, Algeria
Saber Sediki, MD
Maamar Kara, MD
Adel Azaza, MD
Salim Benkhedda, MD, PhD
APHP Hôpital R Muret, Hôpitaux Universitaires de Paris,
Seine Saint Denis, Paris, France
Jean-Jacques Monsuez, MD, PhD,
jean-jacques.monsuez@aphp.fr