Primary PCI 2003 ESC AMI Guidelines EvidenceLevel of Evidence Recommendations Class IAPreferred treatment if performed by experienced team < 90 min after first medical contact. Class ICIndicated for patients in shock and those with contraindications to fibrinolytic therapy Class I Class IIa AAAA GP IIb/IIIa antagonists and primary PCI no stenting with stenting European Heart Journal 2003;24:28-66.
Mortality Outcomes through 1 Year ACE 80 85 90 95 100 0306090120150180210240270300330360 Survival (%) p=.043 95 ± 2 89 ± 2 Stenting plus Abciximab Stenting Alone Time (days) Dr Antonucci, Oral presentation, AHA 2003 5,6 % Absolute Reduction NNT 18
Cardiogenic Shock Meta-analysis Clinical Outcomes at 30 Days All cause Mortality p<0.0001 Any BleedingMajor Bleeding p=NS p<0.02 Control (n=226)Abciximab (n=240) % of patients RR 42.4% AR 18.4% Dr Phil Reid, Oral presentation, ESC 2003 NNT: 5
“Unless or until there are new data available, we should regard catheter-based reperfusion with adjunctive abciximab therapy as the preferred reperfusion therapy for acute MI.” Topol, Neumann & Montalescot JACC 2003; 42:1886-9
Summary Primary PCI with ReoPro remains the gold-standard Facilitated PCI strategy is a work in progress Pre-hospital/ early ReoPro …more data awaited from FINESSE The time-window of Primary PCI may be extended by ReoPro but Phase 3 data needed The platelet is pivotal to Prim. PCI outcomes !