A Cleveland Clinic-led international study is reporting that administering clot busting and anti platelet agents in patients waiting to receive an angioplasty is not of significant benefit compared to an antiplatelet administered just prior to angioplasty.
Researchers led by Stephen Ellis, M.D., a Cardiologist at Cleveland Clinic, set out to determine if drug therapy could be given prior to angioplasty to begin opening arteries, benefiting patients, without increasing risk and reducing mortality among patients whose angioplasties were delayed.Angioplasties are a catheter-based procedure commonly used to widen arteries, have been shown to be the best therapy for most heart attack patients, reducing both mortality and associated stroke compared to clot-busting therapy. However, delays until treatment are common as many hospitals do not offer angioplasty and the delays increase the risk of death.During the FINESSE (Facilitated INtervention with Enhanced Reperfusion Speed to Stop Events) trial, researchers tested the use of reteplase (a clot-busting agent) in combination with abciximab (a glycoprotein IIbIIIa inhibitor or antiplatelet), and abciximab alone versus primary angioplasty (primary PCI). Approximately 2,452 patients from 20 countries were enrolled in the trial. All the patients had suffered a heart attack and were referred for angioplasty, but with an expected delay of 1-4 hours.The researchers found that the combination therapy of a reduced dose of reteplase (a thrombolytic) and abciximab (a glycoprotein IIbIIIa inhibitor) did increase measures of blood flow prior to primary angioplasty, but to a lesser extent than expected. In turn, Abciximab just proior to PCI alone did not increase blood flow, according to the research.In the study, the primary endpoint (a combination of death, cardiogenic shock, heart failure and ventricular fibrillation) at 90 days was seen in 10.7% of patients treated with routine angioplasties, 10.5% with the facilitated abciximab alone approach and 9.8% for the combination facilitated approach. The difference was not statistically significant (p= .55). Bleeding was significantly increased with both new therapies. The results appeared to be true across multiple patient subgroups in the study.”We therefore concluded that primary angioplasty with abciximab given in the cath lab remains the preferred approach for patients experiencing heart attacks, even when delays to the cath lab are estimated to last up to four hours,” Dr. Ellis said. “A caveat to this is that some studies have suggested clot-busting therapy alone for the minority of patients presenting to the emergency room within the first two hours or so may be as good as primary angioplasty, but this approach was not tested in the FINESSE trial.(Source: Cleveland Clinic : November 2007)