Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Int J Cardiol. 2012 Mar 8;155(2):230-5. doi: 10.1016/j.ijcard.2010.09.094. Epub 2010 Oct 28.
Early abciximab administration in patients requiring transportation to undergo primary percutaneous coronary intervention (PPCI) has been reported to improve clinical outcome. We aimed to verify whether early administration leads to reduced infarct size (IS), assessed by delayed-enhancement magnetic resonance imaging (DE-MRI).
We randomized 110 patients with acute myocardial infarction with symptom-to-diagnosis time <6h to either early (55 patients) or late (55 patients) abciximab administration. DE-MRI was performed at 4 days and 6 months. The primary end point was IS at 6 months. Secondary end points were the rate of ST-segment elevation resolution ≥ 50% (STR) at 60 min after PPCI, the extent of microvascular obstruction at 4 days, and the change in IS and transmurality at 6 months vs. 4 days.
DE-MRI was performed in 103 patients after 4 days, and in 87 at 6 months. The mean IS at 6 months was 13.8 ± 9.0% in the early vs. 13.0 ± 9.9% in the Late group (P>0.2). Similarly, microvascular obstruction and the change in IS were not significantly different. The Early group showed a significantly higher STR (94.5% vs. 80.0%, P=0.04) and a larger reduction in infarct transmurality (-9.2 ± 7.0% vs. -5.9 ± 6.4%; P=0.03), while a larger reduction in IS was observed only in patients with ECG-to-Cath Lab time >60 min.
Early abciximab administration did not lead to a smaller IS at 6-month DE-MRI, and was associated with a significant reduction in IS and transmurality only in patients with longer transportation time, warranting further investigation in this patient subset.
有报道称，对于需要转院行直接经皮冠状动脉介入治疗（PPCI）的患者，早期给予阿昔单抗可改善临床结局。我们旨在验证早期给药是否可降低经延迟增强磁共振成像（DE-MRI）评估的梗死面积（IS）。
我们将 110 例症状发作至诊断时间＜6 h 的急性心肌梗死患者随机分为早期（55 例）和晚期（55 例）阿昔单抗给药组。在 4 天和 6 个月时进行 DE-MRI。主要终点是 6 个月时的 IS。次要终点是 PPCI 后 60 min 时 ST 段抬高缓解≥50%（STR）的发生率、4 天时的微血管阻塞程度，以及 6 个月时与 4 天时 IS 和透壁性的变化。
在 4 天时，103 例患者进行了 DE-MRI，在 6 个月时，87 例患者进行了 DE-MRI。早期组的 6 个月时 IS 平均值为 13.8%±9.0%，晚期组为 13.0%±9.9%（P＞0.2）。同样，微血管阻塞和 IS 的变化无显著差异。早期组的 STR 更高（94.5% vs. 80.0%，P=0.04），梗死透壁性降低更大（-9.2%±7.0% vs. -5.9%±6.4%；P=0.03），而仅在心电图至导管室时间＞60 min 的患者中观察到 IS 降低更大。
早期阿昔单抗给药并未导致 6 个月时 DE-MRI 的 IS 更小，仅在转运时间较长的患者中与 IS 和透壁性的显著降低相关，这需要在该患者亚组中进一步研究。
