N Abciximab ER vs. Cath Lab, n=200 RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24.

Abciximab ER vs. Cath Lab, n=200

RELAx - MI

Maioli & al. J Am Coll Cardiol 2007;49:1517–24

RELAx - MI


Results - Pre-PCI

RELAx - MI


Results - Post-PCI

Early Late P

TIMI 3 final 92% 92% NS

TFCc final 27±19 32±23 0.09

MBG 2-3 79% 58% 0.001

Réduction ST > 70% 50% 35% 0.03

Pic troponine 115±122 172±267 0.05

∑ 48-h troponine 3329±3481 4165±4076 0.09

RELAx - MI


Results - 1 month

In patients with AMI treated with PPCI, early abciximab improves pre-PCI angiographic findings, post-PCI tissue perfusion, and 1-month left ventricular function recovery, possibly by starting early recanalization of the IRA.

« Early vs. Late »

Godicke & al. Am Heart J 2005;150:1015.e11-1015.e17

6 studies / Abciximab , n=602

« Early vs. Late »

185

2215

2718

33

15

43

31

47

33

0

25

50

75

Early Late /NO

Early Late /NO

Early Late /NO

% T

IMI 2

- 3

Abciximab Tirofiban Eptifibatide

Gibson & al. Am Heart J 2006;152:668275

Les questions

Chez les patients bénéficiant d’une ACT première pour IDM ST +, une administration précoce d’antiGP2b3 apporte-t-elle un bénéfice par rapport à une utilisation péri-PCI en terme de : paramètres angiographiques : OUI critères pronostiques intermédiaires : OUI MACEs (décès, ré-IDM) ?

Aucun essai clinique n’a permis de démontrer individuellement une réduction de mortalité par

l’utilisation d’anti-GP2B3A associé à l’angioplastie première…

13 essais « faible puissance » : Ace, Admiral, Bridging, Erami, Intami, In time, Isar, On time, Rapport, Relax, Reomobile, Tiger , Titan

1 essai « faible risque » :

Cadillac

Méta-analyses

Montalescot & al. JAMA. 2004;292:362-366Keeley & al. Lancet 2006; 367: 579–88

Flux TIMI 3 pré-angioplastie 26 vs. 15% P < 0.001Flux TIMI 3 post-angioplastie 90 vs. 85% P = 0.057Mais….

Décès = NS

Méta-analyses



Re-IDM = NS

Méta-analyses



Urgent revascularization = NS

Méta-analyses



Saignements = NS

En résumé

In a meta-analysis of 6 randomized trials, early administration of Gp IIb/IIIa inhibitors in STEMI appeared to improve coronary patency with favorable trends for clinical outcomes. These findings are supportive of a strategy of facilitated PCI.Further evaluations in adequately powered large trials are awaited to confirm the clinical benefit of this strategy.

Facilitated percutaneous coronary intervention offers no benefit over primary percutaneous coronary intervention in STEMI treatment and should not be used outside the context of randomised controlled trials.

Keeley & al. Lancet 2006; 367: 579–88

Montalescot & al. JAMA. 2004;292:362-366

Cadillac

8,3

4,85,7

4,4

0

5

10

PTCA PTCA+ABCIX STENT STENT+ABCIX

% C

ompo

site

EP

30 joursN=2082P=0.02

Stone & al. N Engl J Med 2002;346:957

Cadillac

20.0

16.5

11.5 10.2

0

10

20

PTCA PTCA+ABCIX STENT STENT+ABCIX

% C

ompo

site

EP

6 moisN=2082P=0.02


Cadillac


Cadillac


2.5% 2.7%

Cadillac


4.5% 4.2%

Cadillac


0.8% 0.8%

Cadillac


1.8% 2.2%

ADMIRAL

† + IDM +RevN=300

Montalescot & al. N Engl J Med 2001;344:1895

Montalescot & al. N Engl J Med 2001;344:1895-903

ADMIRAL


ADMIRAL

3.4 vs. 6.6%


ADMIRAL

3.4 vs. 7.3%


ADMIRAL

Major bleeding + stroke = NS

Méta-analyse « européenne »

Montalescot & al. Eur Heart J 2007;28:443–449

ACE, ADMIRAL, ISAR - n=1101 - Abciximab

Death +MI

Méta-analyse « européenne »

Monlescot & al. Eur Heart J 2007;28:443–449

ACE, ADMIRAL, ISAR - n=1101 - Abciximab

Total mortality

N Abciximab ER vs. Cath Lab, n=200 RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24.

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