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Mechanical reperfusion therapy for acute myocardial infarction: Stent PAMI, ADMIRAL, CADILLAC and beyond
  1. B R Brodie,
  2. T D Stuckey
  1. Greensboro, North Carolina, USA
  1. Correspondence to:
    Dr BR Brodie, 313 Meadowbrook Terrace, Greensboro, NC 27408-6529, USA

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Mechanical reperfusion has gained increasing acceptance as a reperfusion strategy for acute myocardial infarction

Mechanical reperfusion has gained increas ing acceptance as a reperfusion strategy for acute myocardial infarction (AMI) as a result of data from numerous randomised trials showing superior outcomes. Recently, the Stent PAMI, ADMIRAL, and CADILLAC trials have documented further improvement in outcomes with the addition of adjunctive treatment with coronary stents and platelet glycoprotein IIb/IIIa inhibitors.1–3 Grines and colleagues, in the Stent PAMI trial, found that stents reduced target vessel revascularisation (TVR) and major adverse cardiac events (MACE) at six months compared to balloon angioplasty alone.1 (The Stent PAMI trial initially raised some concerns because the incidence of TIMI 3 flow was slightly lower following stenting versus balloon angioplasty, and there was a disturbing trend toward higher mortality in stented patients at six months. These concerns were resolved in the CADILLAC trial). Montalescot and colleagues, in the ADMIRAL trial, found that the use of the platelet glycoprotein IIb/IIIa inhibitor abciximab given before stenting in patients with AMI improved outcomes, resulting in better TIMI flow immediately following stenting and at six months, better recovery of left ventricular function at six months, and lower MACE at 30 days and six months.2

Stone and colleagues, in the recently completed CADILLAC trial, evaluated the combined role of stents and abciximab and documented the lowest event rates of any AMI trial to date (30 day mortality 2.0%, reinfarcation 0.7%, ischaemic TVR 3.3%, and disabling stroke 0.2%).3 CADILLAC, like Stent PAMI, found that stents reduced six month TVR and MACE, but unlike Stent PAMI, found no degradation of TIMI flow and …

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