Abstract
Background - In the presence of ST-elevation myocardial infarction, patients with successful epicardial reperfusion (TIMI 3 flow) but persistent ST elevation on a 12-lead ECG are at high risk for subsequent death and left ventricular dysfunction. In the TIMI 14 trial, a dose-ranging angiographic study, combined therapy with abciximab plus reduced-dose tPA enhanced the speed and efficacy of epicardial reperfusion. We determined whether the combination of abciximab plus reduced-dose tPA provided additional benefit in terms of myocardial reperfusion, as evidenced by greater resolution of ST elevation. Methods and Results - All 346 patients with interpretable baseline and 90-minute ECGs, treated with either tPA alone or abciximab plus reduced- dose tPA (combination therapy), were included. Patients receiving combination therapy (n=221) had a 59% rate of complete (≥70%) ST resolution at 90 minutes versus 37% in those treated with tPA alone (n=125) (P<0.0001). When the analysis was limited to patients with TIMI 3 flow, patients treated with combination therapy (n=151) remained significantly more likely to achieve complete ST resolution than those receiving tPA alone (n=80) (69% versus 44%; P=0.0002). Conclusions - Combination therapy with abciximab and reduced-dose tPA improves myocardial (microvascular) reperfusion, as reflected in greater ST-segment resolution, in addition to epicardial flow. This finding may translate into improved clinical outcomes by enhancing myocardial salvage.
Original language | English (US) |
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Pages (from-to) | 239-243 |
Number of pages | 5 |
Journal | Circulation |
Volume | 101 |
Issue number | 3 |
DOIs | |
State | Published - Jan 25 2000 |
Keywords
- Electrocardiography
- Microcirculation
- Myocardial infarction
- Reperfusion
- Thrombolysis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)