Glycoprotein Receptor Antagonist Patency Evaluation - GRAPE

Description:

Glycoprotein Receptor Antagonist Patency Evaluation (GRAPE) was a pilot study to evaluate the effect of a strategy of “upstream” or early abciximab administered prior to primary percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) on patency of the infarct-related artery, as determined by initial diagnostic angiography.

Hypothesis:

The goal of the study was to establish rates of epicardial artery patency in patients who were administered abciximab in the emergency room prior to primary PCI.

Study Design

Study Design:

Patients Enrolled: 60
Mean Follow Up: In-hospital
Mean Patient Age: median 63
Female: 30

Patient Populations:

All patients 80 years old or less, symptoms of MI with onset within six hours, and sum of ST-segment elevation 10 mm or more

Exclusions:

Contraindication to antiplatelet therapy, signs of active bleeding, or inability to give informed consent

Primary Endpoints:

Rate of patency (TIMI flow grade 2 or 3) in the infarct-related artery on initial angiography

Secondary Endpoints:

TIMI flow grades on initial angiography or adverse outcomes

Drug/Procedures Used:

Abciximab 250 mcg/kg bolus followed by 10 mcg/min infusion, started in the emergency room and continued for up to 12 hours following revascularization of the infarct-related artery

Concomitant Medications:

Aspirin 160 mg orally and heparin 5000 units intravenously

Principal Findings:

A total of 60 patients were enrolled, with a median of 150 minutes from symptom onset to the abciximab bolus, and a median of 45 minutes from the abciximab bolus to angiography. Forty percent of patients (95% confidence interval [CI] 28-52%) had either TIMI 2 or 3 grade flow on the initial angiogram, and 18% (95% CI 9-28%) had TIMI 3 grade flow.

There was no significant difference in artery patency in subgroups of patients receiving abciximab within 2.5 hours of symptoms or after 2.5 hours (33% vs. 56%, p=NS), and there was no difference in patency between patients having angiography within 45 minutes or after 45 minutes. There were no major hemorrhages, in-hospital strokes, or deaths.

Interpretation:

In this small pilot study, emergency room treatment with abciximab was associated with higher arterial patency rates than reported in other trials in which patients were given only aspirin and heparin. Patency of the infarct-related artery on initial catheterization has been demonstrated to impact clinical outcomes in patients undergoing primary PCI, but whether a strategy of early glycoprotein IIb/IIIa inhibition can affect clinical outcomes by improving flow grades remains untested.

References:

van den Merkhof LF, Zijlstra F, Olsson H, et al. Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty. Results of the Glycoprotein Receptor Antagonist Patency Evaluation (GRAPE) pilot study. J Am Coll Cardiol 1999;33:1528-32.

Clinical Topics: Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention

Keywords: Myocardial Infarction, Stroke, Platelet Aggregation Inhibitors, Catheterization, Heparin, Emergency Service, Hospital, Immunoglobulin Fab Fragments, Percutaneous Coronary Intervention


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