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ADMIRAL
Abciximab before Direct angioplasty and stenting in Myocardial Infarction Regarding Acute and Long-term follow-up
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Author(s) |
(a) Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, Boulenc JM, Maillard L, Pinton P
(b) Ecollan P, Montalescot G, De La Coussaye JE, Vaque J, Bollaert PE, Barragan P, Pinton P
(c) Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, Boulenc J-M, Maillard L, Pinton P
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Title(s) |
(a) Abciximab associated with primary angioplasty and stenting in acute myocardial infarction: the ADMIRAL study, 30-day results
(b) Prehospital abciximab administration in the ADMIRAL study
(c) Abciximab associated with primary angioplasty and stenting in acute myocardial infarction: the ADMIRAL study, 30-day final results
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Reference(s) |
(a) Eur Heart J 1999;20:170
(b) Circulation 1999;100 Suppl I:I-86
(c) Circulation 1999;100 Suppl I:I-87
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Disease |
AMI
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Purpose |
To investigate whether early administration of abciximab can improve TIMI flow and clinical outcomes in patients with AMI referred for urgent primary PTCA
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Study design |
Randomised, double-blind, placebo-controlled
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Follow-up |
24 h, 30 days, 6 months
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Patients |
300 patients with evolving AMI of < 12 h, referred for urgent primary PTCA
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Treatment regimen |
Abciximab, 0.25 mg bolus, followed by 0.125 µg/kg/min for 12 h, or placebo
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Concomitant therapy |
Aspirin (6 months) and ticlopidine (1 month for stent implantation). Unfractionated heparin given according to the EPILOG criteria
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Results |
PTCA was performed in 93.1% and stents were implanted in 85.8% of the patients. Patients administered abciximab prehospital had a shorter mean delay to treatment than those administered abciximab in hospital (174 ± 122 min vs 221 ± 150 min; p = 0.15) with better average TIMI (1.4 ± 1.4 vs 0.6 ± 1.1; p = 0.006, and 2.8 ± 1.1 vs 1.7 ± 1.2; p = 0.01) and TIMI 3 (36.0% vs 12.0%; p = 0.004, and 96% vs 78%; p = 0.01) flow rates on immediate and 24-h angiograms, respectively. Coronary stenosis was lower grade (84.6 ± 27.2 vs 94.2 ± 19.0; p = 0.04) in patients treated prehospital. Initial (21.0% vs 10.3%; p < 0.01) and 24-h (85.6% vs 78.4%; p < 0.05) TIMI 3 flow rates were significantly better in the abciximab group. Left ventricular function was
significantly improved at 24 h (54.6 ± 12.3% vs 51.4 ± 12.6%; p < 0.05). At 30 days, there was a significant reduction (-46.5%) in the combined primary endpoint of death, recurrent MI and urgent revascularisation with abciximab compared to placebo (10.7% vs 20.0%; p < 0.03)
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