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Epicardial flow and myocardial reperfusion following abciximab and low-dose thrombolytic therapy for acute myocardial infarction

A.M. Antman, J.A. de Lemos and E. Braunwald1

Harvard Medical School, Brigham and Women's Hospital, Boston MA, U.S.A.

1 Correspondence: Eugene Braunwald, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, U.S.A.

Abstract

Recent evidence from the Thrombolysis in Myocardial Infarction (TIMI) 14 trial suggests that combining reduceddose fibrinolytic therapy with the potent platelet inhibition afforded by a glycoprotein (GP) IIb/IIIa receptor antagonist can help overcome the limitations of fibrinolytic therapy alone. The TIMI 14 investigators found that lowdose alteplase in combination with abciximab significantly increased the incidence of TIMI 3 flow at 60 and 90 min compared with full-dose alteplase. The use of abciximab emerged as one of the three principal determinants of TIMI 3 flow, along with time to treatment and location of the occlusive thrombus. Complete ST-segment resolution, reflecting perfusion at the myocardial tissue level, was a significant predictor of 30-day survival in the TIMI 14 study. Patients treated with abciximab plus reduced-dose fibrinolytic therapy had significantly greater median ST-segment resolution and a significantly higher rate of complete ST-segment resolution than patients given fibrinolytic therapy alone. Similar benefits were observed in TIMI 14 patients who underwent early adjunctive percutaneous coronary intervention following combined therapy with abciximab and reduced-dose fibrinolysis. These findings indicate that a strategy coupling abciximab with reduceddose fibrinolytic therapy not only enhances epicardial flow but also improves myocardial reperfusion following acute myocardial infarction.

Key Words: Abciximab • GP IIb/IIIa receptor • TIMI 14 • perfusion • microvascular • ST-segment resolution


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