n Abciximab ER vs. Cath Lab, n=200 RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24

RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24 n Results - Pre-PCI

RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24 n Results - Post-PCI EarlyLateP TIMI 3 final92% 92%NS TFCc final27±19 32± MBG 2-379%58%0.001 Réduction ST > 70%50%35%0.03 Pic troponine115± ± h troponine3329± ±

RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24 n Results - 1 month In patients with AMI treated with PPCI, early abciximab improves pre-PCI angiographic findings, post-PCI tissue perfusion, and 1-month left ventricular function recovery, possibly by starting early recanalization of the IRA.

« Early vs. Late » Godicke & al. Am Heart J 2005;150:1015.e e17 n 6 studies / Abciximab, n=602

« Early vs. Late » EarlyLate / NO EarlyLate / NO EarlyLate / NO % TIMI AbciximabTirofibanEptifibatide Gibson & al. Am Heart J 2006;152:668275

Les questions n Chez les patients bénéficiant dune ACT première pour IDM ST +, une administration précoce dantiGP2b3 apporte-t-elle un bénéfice par rapport à une utilisation péri-PCI en terme de : u paramètres angiographiques : OUI u critères pronostiques intermédiaires : OUI u MACEs (décès, ré-IDM) ?

Aucun essai clinique na permis de démontrer individuellement une réduction de mortalité par lutilisation danti-GP2B3A associé à langioplastie première… 13 essais « faible puissance » : Ace, Admiral, Bridging, Erami, Intami, In time, Isar, On time, Rapport, Relax, Reomobile, Tiger, Titan 1 essai « faible risque » : Cadillac

Méta-analyses Montalescot & al. JAMA. 2004;292: Keeley & al. Lancet 2006; 367: 579–88 Flux TIMI 3 pré-angioplastie26 vs. 15%P < Flux TIMI 3 post-angioplastie90 vs. 85%P = Mais…. Décès = NS

Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < Flux TIMI 3 post-angioplastie90 vs. 85%P = Mais…. Montalescot & al. JAMA. 2004;292: Keeley & al. Lancet 2006; 367: 579–88 Re-IDM = NS

Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < Flux TIMI 3 post-angioplastie90 vs. 85%P = Mais…. Montalescot & al. JAMA. 2004;292: Keeley & al. Lancet 2006; 367: 579–88 Urgent revascularization = NS

Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < Flux TIMI 3 post-angioplastie90 vs. 85%P = Mais…. Montalescot & al. JAMA. 2004;292: Keeley & al. Lancet 2006; 367: 579–88 Saignements = NS

En résumé In a meta-analysis of 6 randomized trials, early administration of Gp IIb/IIIa inhibitors in STEMI appeared to improve coronary patency with favorable trends for clinical outcomes. These findings are supportive of a strategy of facilitated PCI. Further evaluations in adequately powered large trials are awaited to confirm the clinical benefit of this strategy. Facilitated percutaneous coronary intervention offers no benefit over primary percutaneous coronary intervention in STEMI treatment and should not be used outside the context of randomised controlled trials. Keeley & al. Lancet 2006; 367: 579–88 Montalescot & al. JAMA. 2004;292:

Cadillac 8,3 4,8 5,7 4, PTCAPTCA+ABCIXSTENTSTENT+ABCIX % Composite EP 30 jours N=2082 P=0.02 Stone & al. N Engl J Med 2002;346:957

Cadillac PTCAPTCA+ABCIXSTENTSTENT+ABCIX % Composite EP 6 mois N=2082 P=0.02 Stone & al. N Engl J Med 2002;346:957

Cadillac Stone & al. N Engl J Med 2002;346:957

Cadillac Stone & al. N Engl J Med 2002;346: %2.7%

Cadillac Stone & al. N Engl J Med 2002;346: %4.2%

Cadillac Stone & al. N Engl J Med 2002;346: %

Cadillac Stone & al. N Engl J Med 2002;346: %2.2%

ADMIRAL + IDM +Rev N=300 Montalescot & al. N Engl J Med 2001;344:1895

Montalescot & al. N Engl J Med 2001;344: ADMIRAL

Montalescot & al. N Engl J Med 2001;344: ADMIRAL 3.4 vs. 6.6%

Montalescot & al. N Engl J Med 2001;344: ADMIRAL 3.4 vs. 7.3%

Montalescot & al. N Engl J Med 2001;344: ADMIRAL Major bleeding + stroke = NS

Méta-analyse « européenne » Montalescot & al. Eur Heart J 2007;28:443–449 n ACE, ADMIRAL, ISAR - n= Abciximab Death +MI

Méta-analyse « européenne » Monlescot & al. Eur Heart J 2007;28:443–449 n ACE, ADMIRAL, ISAR - n= Abciximab Total mortality