Original title: Intralesional abciximab and thrombus aspiration in patients with large anterior myocardial infarction: One-year results from the INFUSE-AMI trial. Reference: Stone GW et al. Circ Cardiovasc Interv. 2013;Epub ahead of print.
The intra-coronary infusion of Abciximab added to thromboaspiration seems to improve outcomes at one year in patients undergoing primary angioplasty for ST-segment elevation with anterior myocardial infarction (AMI). Anyway, these findings should be considered hypothesis generating until confirmed by a study with adequate power to differentiate clinical end points. The INFUSE -AMI included 452 patients experiencing in a heart with ST-segment elevation with anterior myocardial infarction within 5 hours of symptom onset. All received primary angioplasty and anticoagulation with bivalirudin and 2×2 bolus of abciximab intra coronary versus placebo and manual thromboaspiration versus not aspiration.
The results at 30 days were published already in JAMA and showed that abciximab, but not thromboaspiration, reduced infarct size (primary endpoint). The present study depicts the results at one year, where thromboaspiration only showed benefit in terms of new admissions for heart failure ( 0.9 % versus 5.4 %, P = 0.008 ) but no differences in the balance of the points. Between 30 days and one year the Abciximab was associated with lower mortality ( 1.4 % versus 4.9 %, P = 0.04 ) and a lower rate of combined events (death, reinfarction , stroke or revascularization justified by the clinic , 3.3 % versus 7.8 %, P = 0.04 ) but when consider the whole year, the difference in combined events is reduced. The average size of infarction at 30 days was 17% of the total volume of the left ventricle, infarction patients below this cut showed lower mortality at one year, less new admissions for heart failure, lower stent thrombosis and events combined.
Conclusion:
In patients experiencing ST-segment elevation with acute anterior myocardial infarction (AMI) undergoing primary angioplasty using bivalirudin, intra coronary infusion of Abciximab and thromboaspiration could provide long-term benefit.
Editorial comment:
It is reasonable that there is a relationship between infarct size and future events, however given the modest sample size, the probability cannot be excluded. This reasonable doubt has been grown specifically for thromboaspiration especially since recent works with many more patients than the INFUSE -AMI failed to demonstrate a clear benefit.
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