Effect of abciximab therapy in patients undergoing coronary angioplasty for acute st-elevation myocardial infarction complicated by cardiogenic shock

Abstract

Background: The effect of abciximab on survival in patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) undergoing primary percutaneous coronary intervention (PCI) is not clear. Methods and Results: We evaluated outcome in 410 consecutive patients with STEMI and CS who underwent PCI treated without (n=123) or with (n=287) abciximab. The endpoint was survival at 1-year follow-up. The predictors of death at 1 year were also investigated. The groups with and without abciximab had similar survival at 1-year followup. Propensity score-adjusted Cox proportional hazards model identified age (adjusted hazard ratio [HR], 1.02; 95% confidence interval [95% CI]: 1.01–1.03, P=0.001), oro-tracheal intubation (HR, 1.49; 95% CI: 1.12–1.96, P=0.05), post-PCI TIMI flow grade 0–1 (HR, 2.08; 95% CI: 1.52–2.83, P=0.0001) but not abciximab use (HR, 1.08; 95% CI: 0.70–1.60, P=0.60) as independent predictors of death at 1-year follow-up. Cox adjusted 1-year survival rates were 42.8% and 51.6%, (P=0.56) in patients treated without vs. with abciximab, respectively. Conclusions: Patients with STEMI complicated by CS undergoing PCI treated with or without abciximab have similar 1-year survival rates; age, final TIMI 0–1 and oro-tracheal intubation are predictors of death.