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Drug Therapy Offers Little Benefit for Some Patients Undergoing Angioplasty or Stent Procedure

Chicago: Use of the drug pexelizumab immediately before and for 24 hours after stent placement or angioplasty for certain heart attack patients did not have any significant// treatment effect compared to placebo, according to a study in the issue of JAMA. The medication had shown promise in preliminary studies.

Acute ST-elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) is a major public health problem, not only in western countries but increasingly in developing countries. In the United States, there are estimated to be more than half a million STEMI events annually, which has spurred efforts to improve treatments, according to background information in the article. Reperfusion (restoring blood flow) with percutaneous transluminal coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) is highly effective at improving outcomes in patients with acute STEMI, especially if delivered promptly in an expert facility. However, in patients without prompt reestablishment of adequate coronary blood flow, risk of death remains high, indicating the need for new treatments, including drugs intended to reduce the inflammation associated with a heart attack.

Paul W. Armstrong, M.D., of the University of Alberta, Edmonton, Canada, and investigators with the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial, evaluated the effectiveness of the intravenous administration of the medication pexelizumab in conjunction with primary PCI in lowering the risk of death from STEMI. The double-blind, placebo-controlled, phase 3 study include 5,745 patients, of whom 2,885 were randomly assigned to receive placebo and 2,860 to receive pexelizumab, prior to PCI followed by infusion over the subsequent 24 hours. The patients were treated at 296 hospitals in 17 countries from July 2004 to May 2006.

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