Intracoronary abciximab significantly reduces STEMI mortality risk
MedWire News: Administering abciximab through the intracoronary route, instead of intravenously, significantly reduces mortality risk in patients with STEMI, show findings from a meta-analysis.
Abciximab is regularly used for the treatment of STEMI (ST-segment elevation myocardial infarction) patients undergoing primary percutaneous coronary intervention (PCI). Intracoronary abciximab bolus administration has been proposed as an alternative to the standard intravenous route, but it is uncertain whether using the intracoronary route improves clinical outcomes.
To investigate, Federico Piscione (Federico II University, Naples, Italy) and co-researchers analyzed data from 1198 STEMI patients enrolled in five clinical trials assessing the occurrence of all-cause death and reinfarction at 30 days following intravenous versus intracoronary abciximab. Secondary endpoints included all-cause death, reinfarction, and target-vessel revascularization (TVR).
At 30-day follow up, the composite endpoint of death and reinfarction occurred among 4.2% of patients, with intracoronary abciximab use associated with a significant 48% reduction in this composite endpoint compared with intravenous abciximab (hazard ratio [HR]=0.52; 2.9 vs 5.5%).
After adjusting for baseline Thrombolysis In Myocardial Infarction (TIMI) flow grade, the risk for composite death and reinfarction (adjusted HR [aHR]=0.56) and death (aHR=0.43) were significantly lower among patients who received intracoronary versus intravenous abciximab.
Significant predictors for 30-day primary endpoint occurrence included age (aHR=1.05), three-vessel disease (aHR=2.76), and previous myocardial infarction (aHR=2.01).
A total of 29 patients (2.4%) died and 25 patients (2.1%) suffered reinfarction. Intracoronary abciximab significantly decreased mortality rates compared with the intravenous route (HR=0.44; 1.5% vs 3.4%), without impacting reinfarction rates.
This finding suggests that the significant reduction in the composition endpoint of death and reinfarction at 30-day follow up is primarily driven by a lower occurrence of death.
TVR was required in a total of 44 patients (3.7%). Intracoronary abciximab administration was found to significantly reduce TVR compared with the intravenous route (HR=0.53; 2.6 vs 4.8%).
Writing in Heart, the researchers say that ongoing multicenter randomized studies, such as the Abciximab Intracoronary versus Intravenous Drug Application in STEMI (AIDA STEMI) and the INFUSE- Anterior Myocardial Infarction (AMI) trials, will provide a more definite answer as to whether the intracoronary route is indeed superior.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Ingrid Grasmo