• Ayman K M Hassan, Su San Liem, Frank van der Kley, Sandrin C Bergheanu, Ron Wolterbeek, Jan Bosch, Marianne Bootsma, Katja Zeppenfeld, Arnoud van der Laarse, Douwe E Atsma, J Wouter Jukema, and Martin J Schalij.
• Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
• Catheter Cardiovasc Interv. 2009 Aug 1;74(2):335-43.

ObjectivesOur aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short, and long term outcomes.BackgroundEarly abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains indistinct.MethodsWithin a fixed protocol for PPCI, December 2006 was the cut-off point for this prospective study. A total of 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (in-hospital group), and 89 patients received abciximab bolus in the ambulance (in-ambulance group).ResultsThe two groups were comparable for baseline and angiographic characteristics. The in-ambulance group received abciximab within the golden period (median 63 min). The infarct related artery (IRA) patency at onset of the PCI was four times higher in the in-ambulance group compared to in-hospital group (odds ratio = 4.9, 95% CI 2.4-10.1). Enzymatic infarct size was smaller in the in-ambulance group (cumulative 48-h CK release 8011 vs. 11267 U/L, P = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI measured by myocardial scintigraphy (59% vs. 54%, P = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs.11%, P = 0.04).ConclusionEarly abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up.(c) 2009 Wiley-Liss, Inc.

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