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The Detrimental Impact of Chronic Renal Insufficiency

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Infarct Size after Primary Angioplasty Patients With Bivalirudin Compared to Unfractionated Heparin Plus Abciximab in STEMI: The HORIZONS-AMI MRI Substudy – PowerPoint PPT presentation

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Title: The Detrimental Impact of Chronic Renal Insufficiency


1
Infarct Size after Primary Angioplasty Patients
With Bivalirudin Compared to Unfractionated
Heparin Plus Abciximab in STEMI The
HORIZONS-AMI MRI Substudy
Jochen Wöhrle, Nico Merkle, Thorsten Nusser,
Markus Kunze, Eugenia Nikolsky, Akiko Maehara,
Alexandra J Lansky, Roxana Mehran, Gregg W Stone
2
Disclosures
  • Jochen Wöhrle None
  • Nico Merkle None
  • Thorsten Nusser None
  • Markus Kunze None
  • Eugenia Nikolsky None
  • Akiko Maehara None
  • Alexandra J Lansky Grant support The Medicines
    Company
  • Roxana Mehran Grant support, Lecture fees The
    Medicines Company
  • Gregg W. Stone Advisory Board Boston
    Scientific Abbott

3
Background
  • Primary PCI is the preferred reperfusion strategy
    in patients with ST elevation myocardial
    infarction
  • In the HORIZONS-AMI trial, 3602 pts were
    randomized to treatment with bivalirudin or
    unfractionated heparin glycoprotein IIb/IIIa
    inhibitor (UFHGPI). Within 12 months, there was
    a significant reduction of bleeding events and
    cardiac death in pts treated with bivalirudin as
    compared to UFHGPI (eptifibatide or abciximab).

4
Background
  • Abciximab has been reported to reduce
    microvascular obstruction and infarct size in
    STEMI.
  • Cardiac magnetic resonance imaging (CMRI) is a
    powerful tool to assess infarct size,
    microvascular obstruction and left ventricular
    function and volumes.
  • Whether there are differences in infarct size, LV
    ejection fraction and volumes determined in CMRI
    between STEMI patients with primary PCI treated
    with bivalirudin or UFHabciximab has not been
    addressed so far.

5
Harmonizing Outcomes with Revascularization and
Stents in AMI
Patients with STEMI with symptom onset 12
hours ASA 500mg i.v. Clopidogrel 600mg loading
dose
R 11
Bivalirudin monotherapy ( provisional abciximab)
UFH Abciximab
6
Baseline Characteristics (i)
7
Baseline Characteristics (ii)
8
TIMI Flow pre and post PCI
9
Study Drugs and Stents
Plt0.001 Plt0.05
Bailout for giant thrombus or refractory no
reflow after PCI. CCL cardiac catheterization
laboratory
10
Drug therapy
11
CMRI Baseline Data
12
CMRI Infarct size
13
CMRI LVEF
14
CMRI LVEDVI
15
CMRI LVESVI
16
CMRI LVSVI
p 0.76
p 0.21
mL/m²
mL/m²
p 0.15
Baseline
6 months
Difference baseline -6 months
median
38.4 31.343.6
40.5 34.549.1
44.4 40.149.8
45.1 39.655.1
9.8 3.612.8
5.8 -0.511.4
37.6 8.1
41.3 7.0
45.9 7.6
48.0 11.3
mean
8.9 8.1
6.4 9.9
17
Conclusions
  • In the prospective randomized HORIZONS-AMI trial
    including patients with primary PCI with stent
    implantation for STEMI, treatment with
    bivalirudin as compared to UFHabciximab did not
    show a difference in CMRI parameters at baseline
    and at 6 months, including microvascular
    obstruction, infarct size, LV-EF and LV volumes.
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