STEMI Patients:

According to American Heart Association statistics, it is estimated that 1.2 million people will suffer a heart attack this year, and of those, a staggering 40% will die. Advances in pharmalogic and mechanical reperfusion strategies continue to emerge for AMI.

Management of STEMI Patients Undergoing Primary PCI

"Evidence exists that expeditious restoration of flow in the obstructed infarct artery after the onset of symptoms in STEMI patients is a key determinant of short- and long-term outcomes regardless of whether reperfusion is accomplished by fibrinolysis or PCI."1

ADMIRAL: TIMI grade 3 flow before and after PCI

The primary endpoint of the ADMIRAL trial was a composite of death, reinfarction, or urgent target vessel revascularization (TVR) at 30 days after randomization [ReoPro + stent 6.0% (n=149), placebo + stent 14.6% (n=151), relative risk 0.41, 95% confidence interval(CI) 0.18-0.93].2

Chart showing that ReoPro improves coronary artery flow

The primary endpoint of the ACE trial was a composite of death from any cause, reinfarction, TVR and stroke within 1 month of the index procedure [ReoPro + stent 4.5% (n=200), stenting alone 10.5% (n=200); p=0.023].3

ReoPro Improves Myocardial Function in Primary PCI Patients

"Assessment of LV function after STEMI has been shown to be one of the most accurate predictors of future cardiac events in both the prereperfusion and the reperfusion eras."1

ReoPro improves myocardial function

Chart showing that ReoPro improves myocardial function

The primary endpoint of the ADMIRAL trial was a composite of death, reinfarction, or urgent TVR at 30 days after randomization [ReoPro + stent 6.0% (n=149), placebo + stent 14.6% (n=151), relative risk 0.41, 95% CI 0.18-0.93].2

ReoPro (abciximab) has been extensively studied in primary PCI for STEMI

ReoPro (abciximab) has been extensively studied in primary PCI for STEMI (Click image to enlarge)

Click graphic to enlarge

CABG = coronary artery bypass graft; D = death; MI = myocardial infarction; PTCA = percutaneous transluminal coronary angioplasty; RR = relative reduction; TVR = target vessel revascularization; UTVR = urgent target vessel revascularization

*Primary clinical endpoint
†The primary endpoint was death, reinfarction, or any TVR at 6 months by intention-to-treat (ITT) analysis (placebo 28.1%[n=242] vs. ReoPro 28.2% [n=241]; p=0.90). Thus, patients were analyzed according to the groups to which they were randomized, regardless of whether they received or adhered to their alocated treatment.
‡The primary endpoint was a composite of all-cause mortality, reinfarction, ischemia-driven TVR, or disabling stroke during the first 6 months after the index procedure (PTCA 20.0% [n=518], PTCA + ReoPro 16.5% [n=528], stenting 11.5% [n=512], stenting + ReoPro 10.2% [n=524]); P<0.001.6
§Patients assigned to usual care were administered heparin 10,000 U intra-arterially, followed by intravenous heparin infusion 1000 U/h for the first 12 hours after sheath removal.

For definitions of class and level of evidence, see: http://www.acc.org/qualityandscience/clinical/statements.htm

2005 ACC/AHA PCI Guidelines for Use of ReoPro in Primary PCI Patients

ReoPro received a Class IIa recommendation:

"It is reasonable to start treatment with abciximab as early as possible before primary PCI (with or without stenting) in patients with STEMI. (Level of Evidence B)."1

ReoPro is indicated as an adjunct to PCI for prevention of cardiac ischemic complications in patients undergoing PCI.

  1. Begin treatment 10-60 min before PCI
    IV bolus: 0.25 mg/kg
  2. Follow with IV infusion:
    0.125 µg/kg/min (maximum of 10 µg/min) for 12 hours

Page references

  1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: Executive Summary: A report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients With Acute Myocardial Infarction). Circulation 2004;110:588-636.
  2. ADMIRAL N Engl J Med 2001;344:1895-903.
  3. ACE. J Am Coll Cardiol. 2003;42:1879-1885.
  4. EPIC. Am J Cardiol. 1996;77:1045-51.
  5. RAPPORT. Cisculation. 1998;98:734-41.
  6. CADILLAC. Circulation. 2003;108:1316-1323.
  7. ISAR-2. J Am Coll Cardiol. 2000;35:915-921.
  8. ACE. Circulation. 2004;109:1704-1706.
  9. CADILLAC. N Engl J Med 2001;344:957-66.

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