[The use of Abciximab in patients with acute myocardial infarction undergoing direct percutaneous coronary revascularization]. / Utilização de Abciximab em doentes com enfarte agudo do miocárdio submetidos a angioplastia coronária directa.

ABSTRACT

OBJECTIVE: To evaluate the initial experience, in our Centre, with Abciximab in patients with acute myocardial infarction undergoing direct percutaneous transluminal coronary angioplasty (PTCA). METHODS: Between October 1996 and May 1998, 65 patients (51 males, mean age 56.9 +/- 11 years) underwent direct PTCA for acute myocardial infarction. In thirty-seven patients the myocardial infarction was anterior and 40 had multivessels disease. Mainly to compare the incidence of bleeding complications we considered 2 groups Group A--17 patients submitted to PTCA without the use of Abciximab, and Group B--48 patients submitted to PTCA and to a bolus followed by a 12 hour infusion of Abciximab. All the patients were treated with aspirin and heparin (5,000 to 15,000 U according to ACT) and ticlopidine in case of stent implantation. RESULTS: Percutaneous coronary revascularization was successfully achieved in 92.3% of the patients. The total number of bleeding complications was ten cases (20.8%) in Group B and 1 case (5.8%) in Group A. Most of the bleeding complications in the Abciximab Group were minor and related to the femoral vascular access site (9 cases--18.7%) and were easily resolved with local measures (8 cases). There were also 3 cases of hematemesis and one of oral bleeding, all well tolerated. Major bleeding complications were identified in only one patient of the Abciximab Group related to the vascular access site, however there was an absolutely similar case in Group A (2% versus 5.8%). CONCLUSIONS: Although bleeding complications were more frequent in patients receiving Abciximab, mostly related to the vascular access site, they were transient and well tolerated.