Randomized evaluation of intralesion versus intracoronary abciximab and aspiration thrombectomy in patients with ST-elevation myocardial infarction: The COCTAIL II trial.

Abstract

BACKGROUND:

Thrombus burden and distal embolization are predictive of no-reflow during primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). We sought to compare the efficacy of pharmacological and catheter-based strategies for thrombus in patients with STEMI and high atherothrombotic burden.

METHODS:

Between January 2012 and December 2013, 128 STEMI patients undergoing primary PCI at 5 centers were randomly assigned in a 2 × 2 factorial design to intracoronary (IC) abciximab bolus (via the guide catheter) versus intralesion (IL) abciximab bolus, each with versus without aspiration thrombectomy (AT). Study end points were residual intrastent atherothrombotic burden, defined as the number of cross-sections with residual tissue area >10% as assessed by optical coherence tomography, and indices of angiographic and myocardial reperfusion.

RESULTS:

Residual intrastent atherothrombotic burden did not significantly differ with IL versus IC abciximab (median [interquartile range] 6.0 [1-15] vs 6.0 [2-11], P = .806) and with AT versus no aspiration (6.0 [1-13] vs 6.0 [2-12], P = .775). Intralesion abciximab administration was associated with improved angiographic myocardial reperfusion in terms of thrombolysis in myocardial infarction (TIMI) flow (3 [3-3] vs 3 [2-3], P = .040), corrected TIMI frame count (12 ± 5 vs 17 ± 16, P = .021), and myocardial blush grade (3 [2-3] vs 3 [2-3], P = .035). In particular, IL abciximab was associated with higher occurrence of final TIMI 3 flow (90% vs 73.8%, P = .032) and myocardial blush grade 3 (71.6% vs 52.4%, P = .039). Conversely, AT had no significant effect on indices of angiographic or myocardial reperfusion.

CONCLUSIONS:

In patients with STEMI and high thrombotic burden, neither IL versus IC abciximab nor AT versus no aspiration reduced postprocedure intrastent atherothrombotic burden in patients with STEMI undergoing primary PCI. However, IL abciximab improved indices of angiographic and myocardial reperfusion compared to IC abciximab, benefits not apparent with AT.

• Authors: Francesco Prati, Enrico Romagnoli, Ugo Limbruno, Tomasz Pawlowski, Silvio Fedele, Laura Gatto, Luca Di Vito, Alessandro Pappalardo, Vito Ramazzotti, Andrea Picchi, Antonio Trivisonno, Laura Materia, Piotre Pfiatkosky, Giulia Paoletti, Valeria Marco, Luigi Tavazzi, Francesco Versaci, Gregg W Stone
• Journal: American heart journal (Am Heart J) Vol. 170 Issue 6 Pg. 1116-23 (Dec 2015) ISSN: 1097-6744 [Electronic] United States
• PMID: 26678633 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Abciximab

Topics

• Abciximab
• Aged
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Coronary Angiography (methods)
• Coronary Restenosis (diagnosis, etiology, therapy)
• Female
• Humans
• Immunoglobulin Fab Fragments (administration & dosage, adverse effects)
• Male
• Middle Aged
• Myocardial Infarction (complications, diagnosis)
• Myocardial Reperfusion (methods)
• No-Reflow Phenomenon (diagnosis, etiology, therapy)
• Percutaneous Coronary Intervention (adverse effects, methods)
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Postoperative Complications (diagnosis, therapy)
• Thrombectomy (adverse effects, methods)
• Thrombosis (diagnosis, etiology, therapy)
• Tomography, Optical Coherence (methods)
• Treatment Outcome