Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention : The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial
Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bo...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2008-07, Vol.118 (1), p.49-57 |
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| creator | THIELE, Holger SCHINDLER, Kathrin SCHULER, Gerhard FRIEDENBERGER, Josef EITEL, Ingo FÜRNAU, Georg GREBE, Eigk ERBS, Sandra LINKE, Axel MOBIUS-WINKLER, Sven KIVELITZ, Dietmar |
| description | Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus.
Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05).
Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.107.747642 |
| format | Article |
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Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05).
Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.107.747642</identifier><identifier>PMID: 18559698</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Angioplasty, Balloon, Coronary - methods ; Antibodies, Monoclonal - administration & dosage ; Antibodies, Monoclonal - adverse effects ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Coronary heart disease ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Heart ; Humans ; Immunoglobulin Fab Fragments - administration & dosage ; Immunoglobulin Fab Fragments - adverse effects ; Infusions, Intravenous ; Injections, Intra-Arterial ; Injections, Intravenous ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Microcirculation - drug effects ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Reproducibility of Results ; Risk Factors ; Survival Analysis ; Thrombolytic Therapy - methods ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2008-07, Vol.118 (1), p.49-57</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c329t-be3ea72da092db7018b31ecf483cd642faa20a49de1b1f4bef2b43a61e9a4cdb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3678,27915,27916</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20482111$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18559698$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>THIELE, Holger</creatorcontrib><creatorcontrib>SCHINDLER, Kathrin</creatorcontrib><creatorcontrib>SCHULER, Gerhard</creatorcontrib><creatorcontrib>FRIEDENBERGER, Josef</creatorcontrib><creatorcontrib>EITEL, Ingo</creatorcontrib><creatorcontrib>FÜRNAU, Georg</creatorcontrib><creatorcontrib>GREBE, Eigk</creatorcontrib><creatorcontrib>ERBS, Sandra</creatorcontrib><creatorcontrib>LINKE, Axel</creatorcontrib><creatorcontrib>MOBIUS-WINKLER, Sven</creatorcontrib><creatorcontrib>KIVELITZ, Dietmar</creatorcontrib><title>Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention : The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus.
Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05).
Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - methods</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Antibodies, Monoclonal - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Immunoglobulin Fab Fragments - administration & dosage</subject><subject>Immunoglobulin Fab Fragments - adverse effects</subject><subject>Infusions, Intravenous</subject><subject>Injections, Intra-Arterial</subject><subject>Injections, Intravenous</subject><subject>Kaplan-Meier Estimate</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microcirculation - drug effects</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Reproducibility of Results</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>Thrombolytic Therapy - methods</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUk1v1DAQDQhEl8JfQOYAtyyx43xxC1FpIy10VbLlGE2cydYosYOdrWh_fb2bhYpbL_4Yv_fmzXg87z0NlpTG9FNRXhWbVV6Vl9_zi3xJg2SZ8CTm7Lm3oBHjPo_C7IW3CIIg85OQsRPvtbW_3DUOk-iVd0LTKMriLF08i0s1GRDaaAXmjhR6GMFgS37K6YYc3m5R6Z0lX3Tv1rwR8o8coCH5OPZSwCS1IlKRtTuhmuxM_FH5Zz3ezq_f7rQA00ronWAHRhyiG9Wi2WqptmRtnKJLvkYjdhMo3Ocr_lpyJtA4EwfWZ1LdILkC1epB3jufK5TjvdySchjQpZjwKSqPVZTX5BqNdciy2JfxBOOVcYE33ssOeotvj_upt_l6VhUX_uryvCzylS9Clk1-gyFCwloIMtY2SUDTJqQoOp6GonX_1QGwAHjWIm1oxxvsWMNDiClmwEXbhKfex1l3NPr3Du1UD9IK7Pu5vjrOWBLHEXfAbAYKo6012NXj3NWaBvV-aOr_h8aFk3oeGsd9d0yya1wXH5nHKXGAD0cAWAF9Z0AJaf_hWMBTRikNHwAViNZM</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>THIELE, Holger</creator><creator>SCHINDLER, Kathrin</creator><creator>SCHULER, Gerhard</creator><creator>FRIEDENBERGER, Josef</creator><creator>EITEL, Ingo</creator><creator>FÜRNAU, Georg</creator><creator>GREBE, Eigk</creator><creator>ERBS, Sandra</creator><creator>LINKE, Axel</creator><creator>MOBIUS-WINKLER, Sven</creator><creator>KIVELITZ, Dietmar</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention : The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial</title><author>THIELE, Holger ; SCHINDLER, Kathrin ; SCHULER, Gerhard ; FRIEDENBERGER, Josef ; EITEL, Ingo ; FÜRNAU, Georg ; GREBE, Eigk ; ERBS, Sandra ; LINKE, Axel ; MOBIUS-WINKLER, Sven ; KIVELITZ, Dietmar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c329t-be3ea72da092db7018b31ecf483cd642faa20a49de1b1f4bef2b43a61e9a4cdb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - methods</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Antibodies, Monoclonal - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Immunoglobulin Fab Fragments - administration & dosage</topic><topic>Immunoglobulin Fab Fragments - adverse effects</topic><topic>Infusions, Intravenous</topic><topic>Injections, Intra-Arterial</topic><topic>Injections, Intravenous</topic><topic>Kaplan-Meier Estimate</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microcirculation - drug effects</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Reproducibility of Results</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>Thrombolytic Therapy - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>THIELE, Holger</creatorcontrib><creatorcontrib>SCHINDLER, Kathrin</creatorcontrib><creatorcontrib>SCHULER, Gerhard</creatorcontrib><creatorcontrib>FRIEDENBERGER, Josef</creatorcontrib><creatorcontrib>EITEL, Ingo</creatorcontrib><creatorcontrib>FÜRNAU, Georg</creatorcontrib><creatorcontrib>GREBE, Eigk</creatorcontrib><creatorcontrib>ERBS, Sandra</creatorcontrib><creatorcontrib>LINKE, Axel</creatorcontrib><creatorcontrib>MOBIUS-WINKLER, Sven</creatorcontrib><creatorcontrib>KIVELITZ, Dietmar</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>THIELE, Holger</au><au>SCHINDLER, Kathrin</au><au>SCHULER, Gerhard</au><au>FRIEDENBERGER, Josef</au><au>EITEL, Ingo</au><au>FÜRNAU, Georg</au><au>GREBE, Eigk</au><au>ERBS, Sandra</au><au>LINKE, Axel</au><au>MOBIUS-WINKLER, Sven</au><au>KIVELITZ, Dietmar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention : The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>118</volume><issue>1</issue><spage>49</spage><epage>57</epage><pages>49-57</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus.
Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus abciximab administration with subsequent 12-hour intravenous infusion. The primary end point was infarct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance. Secondary end points were ST-segment resolution at 90 minutes, Thrombolysis in Myocardial Infarction flow and perfusion grades after PCI, and the occurrence of major adverse cardiac events within 30 days. The median infarct size was 15.1% (interquartile range, 6.1% to 25.2%) in the intracoronary versus 23.4% (interquartile range, 13.6% to 33.2%) in the intravenous group (P=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients (P=0.01). Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8% (interquartile range, 66.7% to 100.0%) versus 70.0% (interquartile range, 45.2% to 83.5%; P=0.006). The Thrombolysis in Myocardial Infarction flow after PCI was not different between treatment groups (P=0.51), but there was a trend toward an improved perfusion grade (P=0.09). There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application (5.2% versus 15.6%; P=0.06; relative risk, 0.33; 95% CI, 0.09 to 1.05).
Intracoronary bolus administration of abciximab in primary PCI is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>18559698</pmid><doi>10.1161/CIRCULATIONAHA.107.747642</doi><tpages>9</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2008-07, Vol.118 (1), p.49-57 |
| issn | 0009-7322 1524-4539 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Aged Angioplasty, Balloon, Coronary - methods Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - adverse effects Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Coronary heart disease Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Heart Humans Immunoglobulin Fab Fragments - administration & dosage Immunoglobulin Fab Fragments - adverse effects Infusions, Intravenous Injections, Intra-Arterial Injections, Intravenous Kaplan-Meier Estimate Magnetic Resonance Imaging Male Medical sciences Microcirculation - drug effects Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - physiopathology Myocardial Infarction - therapy Reproducibility of Results Risk Factors Survival Analysis Thrombolytic Therapy - methods Treatment Outcome |
| title | Intracoronary Compared With Intravenous Bolus Abciximab Application in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention : The Randomized Leipzig Immediate Percutaneous Coronary Intervention Abciximab IV Versus IC in ST-Elevation Myocardial Infarction Trial |
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