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Thromb Haemost 2004; 92(06): 1214-1220
DOI: 10.1160/TH03-11-0678
Theme Issue Article
Schattauer GmbH

Admission troponin T, advanced age and male gender identify patients with improved myocardial tissue perfusion after abciximab administration for ST-segment elevation myocardial infarction

Stephanie Lehrke
1   Medizinische Universitätsklinik Heidelberg, Innere III, Department of Cardiology, Heidelberg, Germany
,
Evangelos Giannitsis
1   Medizinische Universitätsklinik Heidelberg, Innere III, Department of Cardiology, Heidelberg, Germany
,
Hugo A. Katus
1   Medizinische Universitätsklinik Heidelberg, Innere III, Department of Cardiology, Heidelberg, Germany
› Author Affiliations
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Publication History

Received 07 November 2003

Accepted after revision 19 March 2004

Publication Date:
02 December 2017 (online)

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Summary

The aim was to investigate the effect of abciximab on microvascular perfusion in different subgroups of patients undergoing direct PCI for acute STEMI. We enrolled 145 consecutive patients with TIMI grade 3 flow after direct PCI for acute STEMI. The GPIIb/IIIa inhibitor abciximab was administered in 57 patients (39.3%). Myocardial perfusion was the primary outcome measure and was assessed by analysis of cardiac troponin T wash-out. Treatment effects on myocardial perfusion and clinical outcome were tested for predefined subgroups including patients with an admission cTnT > 0.1µg/L, diabetes mellitus, male gender, age > 70 years, and time from symptom onset to reperfusion > 6 hours. A significant improvement of cTnT washout was seen in patients with an admission cTnT ≥ 0.1 µg/L, in males and in older patients. Improved tissue level reperfusion did not translate into a significant reduction of cardiac mortality or the incidence of the combined endpoint consisting of cardiac death, nonfatal reinfarction and need for target vessel revascularisation during 30 dayand long-term follow-up (mean 274 days). In conclusion, adjunctive administration of abciximab improves myocardial perfusion in patients with normal epicardial flow after direct PCI, particularly in patients with an cTnT > 0.1µg/L on admission, age over 70 years and male gender.

Keywords

Troponin T - microcirculation - GP IIb/IIIa inhibitors
 

  • References

  • 1 Stone GW, Grines CL, Cox DA. et al. for the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators. Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction. N Engl J Med 2002; 346: 957-66.
    CrossrefPubMedSearch in Google Scholar
  • 2 Grines CL, Cox DA, Stone GW. et al. for the Stent Primary Angioplasty in Myocardial Infarction Group. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med 1999; 341: 1949-56.
    CrossrefPubMedSearch in Google Scholar
  • 3 Ito H, Tomooka T, Sakai N. et al. Lack of myocardial perfusion immediately after successful thrombolysis. Circulation 1992; 85: 1699-1705.
    CrossrefPubMedSearch in Google Scholar
  • 4 Wu KC, Zerhouni EA, Judd RM. et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998; 97: 765-72.
    CrossrefPubMedSearch in Google Scholar
  • 5 Neumann FJ, Blasini R, Schmitt C. et al. Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation 1998; 98: 2695-701.
    CrossrefPubMedSearch in Google Scholar
  • 6 De Lemos JA, Antman EM, Gibson M. et al. for the TIMI 14 Investigators. Abciximab improves both epicardial flow and myocardial reperfusion in ST-Elevation myocardial infarction. Observations from the TIMI 14 Trial. Circulation 2000; 101: 239-43.
    CrossrefPubMedSearch in Google Scholar
  • 7 Petronino AS, Rovai D, Musumeci G. et al. Effects of abciximab on microvascular integrity and left ventricular functional recovery on patients with acute infarction treated by primary coronary angioplasty. European Heart J 2003; 24: 67-76.
    PubMedSearch in Google Scholar
  • 8 Montalescot G, Barragan P, Wittenberg O. et al. for the ADMIRAL Investigators. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001; 344: 1895-1903.
    CrossrefPubMedSearch in Google Scholar
  • 9 Schömig A, Kastrati A, Dirschinger J. et al. for the Stent versus Thrombolysis for Occluded Arteries in Patients with Acute Myocardial Infarction Study Investigators. Coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. N Engl J Med 2000; 343: 385-91.
    CrossrefPubMedSearch in Google Scholar
  • 10 Wong GC, Morrow DA, Murphy S. et al. for the TACTICS-TIMI 18 Study Group. Elevations in Troponin T and I are associated with abnormal tissue level perfusion. Circulation 2002; 106: 202-7.
    CrossrefPubMedSearch in Google Scholar
  • 11 Giannitsis E, Müller-Bardorff M, Lehrke S. et al. Admission Troponin T level predicts clinical outcomes, TIMI flow, and myocardial tissue perfusion after primary percutaneous intervention for acute ST-Segment elevation myocardial infarction. Circulation 2001; 104630-5.
    PubMedSearch in Google Scholar
  • 12 Frostfeldt G, Gustafsson G, Lindahl B. et al. Possible reasons for the prognostic value of troponin-T on admission in patients with ST-elevation myocardial infarction. Coron Artery Dis 2001; 12: 227-37.
    CrossrefPubMedSearch in Google Scholar
  • 13 Kurowski V, Hartmann F, Killermann DP. et al. Prognostic significance of admission cardiac troponin T in patients treated successfully with direct percutaneous interventions for acute ST-segment elevation myocardial infarction. Crit Care Med 2002; 30: 2229-35.
    CrossrefPubMedSearch in Google Scholar
  • 14 Kameneva MV, Watach MJ, Borovetz HS. Gender difference in rheologic properties of blood and risk of cardiovascular diseases. Clin Hemorheol Microcirc 1999; 21: 357-63.
    PubMedSearch in Google Scholar
  • 15 Angeja BG, De Lemos J, Murphy SA. et al. Impact of diabetes mellitus on epicardial and microvascular flow after fibrinolytic therapy. Am Heart J 2002; 144: 649-56.
    CrossrefPubMedSearch in Google Scholar
  • 16 TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) Trial: phase 1 findings. N Engl J Med 1985; 312: 932-6.
    PubMedSearch in Google Scholar
  • 17 The EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and lowdose heparin during percutaneous coronary revascularisation. N Engl J Med 1997; 336: 1689-96.
    CrossrefPubMedSearch in Google Scholar
  • 18 The CAPTURE Investigators. Randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. Lancet 1997; 349: 1429-35.
    CrossrefPubMedSearch in Google Scholar
  • 19 The PRISM-PLUS Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Qwave myocardial infarction. N Engl J Med 1998; 338: 1488-97.
    CrossrefPubMedSearch in Google Scholar
  • 20 The PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med 1998; 339: 436-43.
    CrossrefPubMedSearch in Google Scholar
  • 21 Kim RJ, Chen EL, Lima JA. et al. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996; 94: 331-26.
    CrossrefPubMedSearch in Google Scholar
  • 22 Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 1995; 71: 699-708.
    PubMedSearch in Google Scholar
  • 23 Topol EJ, Yadav JS. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation 2000; 101: 570-80.
    CrossrefPubMedSearch in Google Scholar
  • 24 Golino P, Ashton JH, McNatt J. et al. Simultaneous administration of thromboxane A2- and serotonin S2-receptor antagonists markedly enhances thrombolysis and prevents or delays reocclusion after tissue-type plasminogen activator in a canine model of coronary thrombosis. Circulation 1989; 79: 911-9.
    CrossrefPubMedSearch in Google Scholar
  • 25 Neumann FJ, Ott I, Gawaz M. et al. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation 1995; 92: 748-55.
    CrossrefPubMedSearch in Google Scholar
  • 26 Ito H, Maruyama, Iwakura K. et al. Clinical implications of the ´no-reflow´phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996; 93: 223-8.
    CrossrefPubMedSearch in Google Scholar
  • 27 Gerber BL, Rochitte CE, Melin JA. et al. Microvascular obstruction and left ventricular remodeling early after acute myocardial infarction. Circulation 2000; 101: 2734-41.
    CrossrefPubMedSearch in Google Scholar
  • 28 Kondo M, Nakano A, Saito D. et al. Assessment of “microvascular no-reflow phenomenon” using technetium-99-m macroaggregated albumin scintigraphy in patients with acute myocardial infarction. J Am Coll Cardiol 1998; 32: 898-903.
    CrossrefPubMedSearch in Google Scholar
  • 29 Ohman EM, Armstrong PW, Christenson RH. et al. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. N Engl J Med 1996; 335: 1333-41.
    CrossrefPubMedSearch in Google Scholar
  • 30 Neumann FJ, Zohlnhöfer D, Fakhoury L. et al. Effect of glycoprotein IIb/IIIa receptor blockade on platelet-leukozyte interaction and surface expression of the leukozyte integrin Mac-1 in acute myocardial infarction. J Am Coll Cardiol 1999; 34: 1420-6.
    CrossrefPubMedSearch in Google Scholar
  • 31 Antman EM, Cooper HA, Gibson CM. et al. for the Thrombolysis in Myocardial Infarction (TIMI) 14 Investigators. Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction; insights from TIMI 14 and InTIME-II. Eur Heart J 2002; 23: 928-33.
    CrossrefPubMedSearch in Google Scholar
  • 32 Matetzky S, Sharir T, Domingo M. et al. Elevated troponin I level on admission is associated with adverse outcome of primary angioplasty in acute myocardial infarction. Circulation 2000; 102: 1611-6.
    CrossrefPubMedSearch in Google Scholar
  • 33 Stubbs P, Collinson P, Moseley D. et al. Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 1996; 94: 1291-7.
    CrossrefPubMedSearch in Google Scholar
  • 34 Antoniucci D, Valenti R, Migliorini A. et al. Direct infarct artery stenting without predilatation and no-reflow in patients with acute mycardial infarction. Am Heart J 2001; 142: 684-90.
    CrossrefPubMedSearch in Google Scholar
  • 35 Sharpe PC, Trinick T. Mean platelet volume in diabetes mellitus. Q J Med 1993; 86: 739-42.
    PubMedSearch in Google Scholar
  • 36 Winocour PD, Perry DW, Kinlough-Rathbone RL. Hypersensitivity to ADP of platelets from diabetic rats associated with enhanced fibrinogen binding. Eur J Clin Invest 1992; 22: 19-23.
    CrossrefPubMedSearch in Google Scholar
  • 37 Bath PMW, Butterworth RJ. Platelet size measurement, physiology and vascular disease. Blood Coagul Fibrin 1996; 07: 157-61.
    CrossrefPubMedSearch in Google Scholar
  • 38 Tschoepe D, Roesen P, Kaufmann L. et al. Evidence for abnormal platelet glycoprotein expression in diabetes mellitis. Eur J Clin Invest 1990; 20: 166-70.
    CrossrefPubMedSearch in Google Scholar
  • 39 Steinhubl SR, Kottke-Marchant K, Moliterno DJ. et al. Attainment and maintenance of platelet inhibition through standard dosing of abciximab in diabetic and nondiabetic patients undergoing percutaneous coronary intervention. Circulation 1999; 100: 1977-82.
    CrossrefPubMedSearch in Google Scholar
  • 40 Marso SP, Lincoff AM, Ellis SG. et al. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus. Results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) Diabetic Substudy. Circulation 1999; 100: 2477-84.
    CrossrefPubMedSearch in Google Scholar
  • 41 The GUSTO V Investigators. Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomized trial. Lancet 2001; 357: 1905-14.
    CrossrefPubMedSearch in Google Scholar