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

Présentation au sujet: "N Abciximab ER vs. Cath Lab, n=200 RELAx - MI Maioli & al. J Am Coll Cardiol 2007;49:1517–24."— Transcription de la présentation:

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

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

3 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±230.09 MBG 2-379%58%0.001 Réduction ST > 70%50%35%0.03 Pic troponine115±122 172±2670.05 48-h troponine3329±34814165±40760.09

4 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.

5 « Early vs. Late » Godicke & al. Am Heart J 2005;150:1015.e11-1015.e17 n 6 studies / Abciximab, n=602

6 « Early vs. Late » 18 5 22 15 27 18 33 15 43 31 47 33 0 25 50 75 EarlyLate / NO EarlyLate / NO EarlyLate / NO % TIMI 2 - 3 AbciximabTirofibanEptifibatide Gibson & al. Am Heart J 2006;152:668275

7 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) ?

8 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

9 Méta-analyses Montalescot & al. JAMA. 2004;292:362-366 Keeley & al. Lancet 2006; 367: 579–88 Flux TIMI 3 pré-angioplastie26 vs. 15%P < 0.001 Flux TIMI 3 post-angioplastie90 vs. 85%P = 0.057 Mais…. Décès = NS

10 Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < 0.001 Flux TIMI 3 post-angioplastie90 vs. 85%P = 0.057 Mais…. Montalescot & al. JAMA. 2004;292:362-366 Keeley & al. Lancet 2006; 367: 579–88 Re-IDM = NS

11 Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < 0.001 Flux TIMI 3 post-angioplastie90 vs. 85%P = 0.057 Mais…. Montalescot & al. JAMA. 2004;292:362-366 Keeley & al. Lancet 2006; 367: 579–88 Urgent revascularization = NS

12 Méta-analyses Flux TIMI 3 pré-angioplastie26 vs. 15%P < 0.001 Flux TIMI 3 post-angioplastie90 vs. 85%P = 0.057 Mais…. Montalescot & al. JAMA. 2004;292:362-366 Keeley & al. Lancet 2006; 367: 579–88 Saignements = NS

13 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;292:362-366

14 Cadillac 8,3 4,8 5,7 4,4 0 5 10 PTCAPTCA+ABCIXSTENTSTENT+ABCIX % Composite EP 30 jours N=2082 P=0.02 Stone & al. N Engl J Med 2002;346:957

15 Cadillac 20.0 16.5 11.5 10.2 0 10 20 PTCAPTCA+ABCIXSTENTSTENT+ABCIX % Composite EP 6 mois N=2082 P=0.02 Stone & al. N Engl J Med 2002;346:957

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

17 Cadillac Stone & al. N Engl J Med 2002;346:957 2.5%2.7%

18 Cadillac Stone & al. N Engl J Med 2002;346:957 4.5%4.2%

19 Cadillac Stone & al. N Engl J Med 2002;346:957 0.8%

20 Cadillac Stone & al. N Engl J Med 2002;346:957 1.8%2.2%

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

22 Montalescot & al. N Engl J Med 2001;344:1895-903 ADMIRAL

23 Montalescot & al. N Engl J Med 2001;344:1895-903 ADMIRAL 3.4 vs. 6.6%

24 Montalescot & al. N Engl J Med 2001;344:1895-903 ADMIRAL 3.4 vs. 7.3%

25 Montalescot & al. N Engl J Med 2001;344:1895-903 ADMIRAL Major bleeding + stroke = NS

26 Méta-analyse « européenne » Montalescot & al. Eur Heart J 2007;28:443–449 n ACE, ADMIRAL, ISAR - n=1101 - Abciximab Death +MI

27 Méta-analyse « européenne » Monlescot & al. Eur Heart J 2007;28:443–449 n ACE, ADMIRAL, ISAR - n=1101 - Abciximab Total mortality