Adverse events more common with reteplase/abciximab-facilitated PCI and abciximab-facilitated PCI.

In-lab administration of abciximab is associated with the best risk-to-benefit profile in patients under¬going primary PCI, according to re¬sults of the FINESSE trial.

Stephen Ellis, MD, from The Cleveland Clinic and a researcher with FINESSE, said primary PCI with in-lab administration of abcix¬imab (ReoPro, Centocor) was supe¬rior to the other two treatments analyzed: primary PCI facilitated with abciximab and primary PCI facilitated with abciximab plus half-dose reteplase (Retavase, Centocor).

“No significant improvement in the primary endpoint or components was observed with either reteplase/abciximab-facilitated PCI or abcix¬imab-facilitated PCI compared with primary PCI with in-lab administra¬tion of abciximab,” Ellis said.

The primary endpoint was a com¬posite at 90 days of all-cause mortal¬ity, rehospitalization or emergency department treatment for CHF, resuscitated ventricular fibrillation more than 48 hours after random¬ization, or cardiogenic shock.

In-lab administration of abciximab was superior to reteplase/abciximab facilitation and abciximab facilita¬tion alone in terms of TIMI major or minor bleeding through discharge or day 7 (Figure).

Reteplase/abciximab administered early was associated with an increase in pre-PCI TIMI-3 flow and more than 70% ST-segment resolution at 60 to 90 minutes. Post-PCI TIMI-3 flow and ST resolution at 180 to 240 minutes were similar among all three strategies.

Ellis said that although the study enrolled only 82% of the planned number of patients, it is unlikely that different results would have been seen with a larger cohort.

He said that pharmacotherapy prior to PCI may be beneficial, particularly because delays due to patient transfer are common. Such delays are associated with an increased risk of mortality. “Early pharmacologic reperfusion pre-PCI may lead to myocardial salvage and better long-term outcomes,” Ellis said.

FINESSE analyzed 2,452 patients with STEMI from 20 countries. All patients presented within 6 hours of the onset of symptoms.

“Early pharmacologic reperfusion pre-PCI may lead to myocardial salvage and better long-term outcomes.”
— Stephen Ellis, MD