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Gated SPECT Evaluation of Outcome After Abciximab-Supported Primary Infarct Artery Stenting for Acute Myocardial Infarction: The Scintigraphic Data of the Abciximab and Carbostent Evaluation (ACE) Randomized Trial

¹ Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
² Division of Cardiology, Careggi Hospital, Florence, Italy

We used gated SPECT to evaluate the impact of abciximab on the efficacy of myocardial reperfusion in patients with acute myocardial infarction undergoing infarct-related artery stenting. Methods: The Abciximab and Carbostent Evaluation (ACE) trial randomized 400 infarct patients to stenting alone or stenting plus abciximab. One-month ^99mTc-sestamibi gated SPECT was planned in a subgroup of consecutive patients to evaluate infarct size, infarct severity, left ventricular volumes, and ejection fraction. Results: The final study population included 182 patients (99 randomized to abciximab and 83 to stenting alone). Gated SPECT revealed smaller infarcts in the abciximab group than in the stenting-alone group (14.3% ± 11.7% vs. 18.1% ± 13%, P < 0.02), and lower infarct severity (minimum-to-maximum count ratio = 0.47 ± 0.17 vs. 0.41 ± 0.15, P < 0.02), resulting in a smaller left ventricular end-diastolic volume index (57.8 ± 20.0 vs. 64.6 ± 20.8 mL/m², P = 0.03) and left ventricular end-systolic volume index (31.7 ± 17.4 vs. 37.5 ± 18.6 mL/m², P = 0.05) in the abciximab group. One-month left ventricular ejection fraction was significantly higher in patients randomized to abciximab (47.4% ± 11.3% vs. 43.9% ± 11.7%, P = 0.05). Conclusion: The use of abciximab therapy as an adjunct to infarct-related artery stenting leads to a reduction in infarct size and severity, resulting in smaller 1-mo left ventricular volumes and better left ventricular function. Gated SPECT appears to be an ideal tool for outcome assessment in infarct patients undergoing different treatment strategies.

Key Words: acute myocardial infarction • angioplasty • gated SPECT • stenting