Combination therapy does not appear to benefit cardiac patients before heart catheter procedure


Patients with acute myocardial infarction (MI - heart attack) who are referred for percutaneous coronary intervention (such as angioplasty and stent placement in the coronary artery) do not have a reduction in the amount of damaged heart tissue when administered two drugs compared with a single drug to restore blood flow, according to a study in the February 25 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, "In hospitals with catheterization facilities, primary percutaneous coronary interventions (PCIs) are better then thrombolysis (drug therapy used to dissolve blood clots) in patients with ST-segment elevation acute MI. Specifically designed randomized trials have also shown that patients with acute MI presenting at hospitals without catheterization facilities benefit more from PCI performed after transfer to centers with catheterization laboratories than from on-site thombolysis."

Adnan Kastrati, M.D., from Deutsches Hezzentrum, Technische Universitat, Munich, Germany, and colleagues from the Bavarian Reperfusion Alternatives Evaluation (BRAVE) Study Investigators, assessed whether early administration of the combination of the drugs reteplase plus abciximab produces better reduction of infarct size compared with abciximab alone in patients with acute MI referred for PCI. The study, conducted from May 3, 2001 through June 2, 2003, included 253 patients who were admitted to 13 community hospitals without catheterization facilities (n=186) and to 5 hospitals with catheterization facilities (n=67), within 12 hours of symptoms of an acute MI. Patients randomly received either the combination of reteplase and abciximab (n=125) or abciximab (n=128) alone. All patients were then transferred for PCI. Infarct size was later determined by imaging from a single-photon emission computed tomography (SPECT).

"The final infarct size of the left ventricle, the primary end point of the trial, was 13 percent in the reteplase plus abciximab group and 11.5 percent in the abciximab group," the researchers report. "The mean (average) difference in final infarct size of the left ventricle between the reteplase plus abciximab group and the abciximab group was 1.3 percent." The researchers noted that several hours after the drug administration, patients receiving the combination therapy had superior blood flow through the blocked artery. The researchers also found, "the cumulative 6-month incidence of the composite end point (death, recurrent MI, or stroke) was also comparable between the two treatment groups, whereas there was a trend toward more major bleeding events with reteplase plus abciximab."

"In conclusion, the findings of this trial show that early administration of reteplase plus abciximab does not lead to a reduction of infarct size compared with abciximab alone in patients with acute MI referred for PCI. In addition, clinical outcome was not improved by combination therapy." (JAMA. 2004;291:947-954. Available post-embargo at

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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