Abciximab ER vs. Cath Lab, n=200
RELAx - MI
Maioli & al. J Am Coll Cardiol 2007;49:1517–24
RELAx - MI
Maioli & al. J Am Coll Cardiol 2007;49:1517–24
Results - Pre-PCI
RELAx - MI
Maioli & al. J Am Coll Cardiol 2007;49:1517–24
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
Maioli & al. J Am Coll Cardiol 2007;49:1517–24
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
Flux TIMI 3 pré-angioplastie 26 vs. 15% P < 0.001Flux TIMI 3 post-angioplastie 90 vs. 85% P = 0.057Mais….
Montalescot & al. JAMA. 2004;292:362-366Keeley & al. Lancet 2006; 367: 579–88
Re-IDM = NS
Méta-analyses
Flux TIMI 3 pré-angioplastie 26 vs. 15% P < 0.001Flux TIMI 3 post-angioplastie 90 vs. 85% P = 0.057Mais….
Montalescot & al. JAMA. 2004;292:362-366Keeley & al. Lancet 2006; 367: 579–88
Urgent revascularization = NS
Méta-analyses
Flux TIMI 3 pré-angioplastie 26 vs. 15% P < 0.001Flux TIMI 3 post-angioplastie 90 vs. 85% P = 0.057Mais….
Montalescot & al. JAMA. 2004;292:362-366Keeley & al. Lancet 2006; 367: 579–88
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
Stone & al. N Engl J Med 2002;346:957
Cadillac
Stone & al. N Engl J Med 2002;346:957
Cadillac
Stone & al. N Engl J Med 2002;346:957
2.5% 2.7%
Cadillac
Stone & al. N Engl J Med 2002;346:957
4.5% 4.2%
Cadillac
Stone & al. N Engl J Med 2002;346:957
0.8% 0.8%
Cadillac
Stone & al. N Engl J Med 2002;346:957
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
Montalescot & al. N Engl J Med 2001;344:1895-903
ADMIRAL
3.4 vs. 6.6%
Montalescot & al. N Engl J Med 2001;344:1895-903
ADMIRAL
3.4 vs. 7.3%
Montalescot & al. N Engl J Med 2001;344:1895-903
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
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