Journal of Invasive Cardiology

ADMIRAL. The Abciximab Before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long-term Follow-up (ADMIRAL) trial was a multicenter, randomized, double-blind, placebo-controlled study designed to examine the effects of abciximab in primary stenting in 300 patients with AMI. Initial TIMI 3 flow rates were 5.4% in the stent-placebo group compared with 16.8% in the stent-abciximab group (p = 0.01). Following stent implantation, TIMI 3 flow at 24 hours rose to 92.6% and 95.9%, respectively, for the placebo and abciximab groups (p < 0.33). A significant increase in left ventricular ejection fraction (LVEF) was also observed at 24 hours in the stent-abciximab group compared with the stent-placebo group (57.0% versus 53.9%, respectively; p < 0.05). There was a significant 59% reduction at 30 days in the composite endpoint of death, recurrent MI or urgent TVR in the stent-abciximab group compared with the stent-placebo group (6.0% versus 14.6%, respectively; p = 0.01). This early benefit was maintained at 6 months, with a similar reduction in the composite endpoint of death, recurrent MI or urgent TVR (7.4% versus 15.9%, respectively; p = 0.02).⁶⁹

ISAR-II. The Intracoronary Stenting and Antithrombotic Regimen (ISAR)-II trial was a randomized, open-label study to evaluate the effect of abciximab on restenosis and clinical outcome in 401 patients following primary stenting. Patients undergoing stenting within 48 hours after AMI onset were assigned to receive either standard-dose heparin or abciximab plus reduced-dose heparin. By 30 days, the composite rates of death, reinfarction or target lesion revascularization were 5.0% for the stent-plus-abciximab group compared with 10.5% for the heparin-only group (p = 0.038). The addition of abciximab to stenting was thus associated with a substantial reduction in major adverse cardiac events at 30 days. However, at 1-year follow-up, abciximab treatment did not provide any additional benefit in reducing the need for target lesion revascularization or the rate of angiographic restenosis.⁷⁰

StopAMI. The Stent Versus Thrombolysis for Occluded Coronary Arteries in Patients with AMI (StopAMI) was a single-center, prospective, randomized study of 140 patients with AMI designed to evaluate the degree of myocardial salvage that could be attained by coronary stenting combined with abciximab compared with fibrinolysis alone using an accelerated-dose regimen of alteplase. Patients in the stent-abciximab group were administered standard-dose abciximab during stent placement and patients in the fibrinolysis group received a standard accelerated dose of alteplase. The primary endpoint of this trial was the degree of myocardial salvage achieved, as determined by serial nuclear scintigraphic studies. A secondary endpoint was the composite of death, reinfarction or stroke within 6 months after randomization.⁶³