Clinical efficacy and safety of intracoronary vs. intravenous abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials

Eliano Pio Navarese, Marek Kozinski, Karolina Obonska, Massimo Margheri, Paul Alfred Gurbel, Jacek Kubica, Giuseppe De Luca

Research output: Contribution to journalArticle

Abstract

Adjunctive therapy with abciximab has been proven to reduce mortality and reinfarction in patients with ST-elevation myocardial infarction (STEMI) referred to invasive management. Standard abciximab regimen consists of an intravenous (IV) bolus followed by a 12-h IV infusion. Experimental studies and small clinical trials suggest the superiority of intracoronary (IC) injection of abciximab over the IV route. We aimed to perform a meta-analysis of randomized controlled trials to assess the clinical efficacy and safety of IC vs. IV abciximab administration in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). The primary endpoint was mortality, while recurrent myocardial infarction and target vessel revascularization (TVR) were selected as secondary endpoints. The safety endpoint was the risk of major bleeding complications. A total of six randomized trials were finally included in the meta-analysis, enrolling a total of 1246 patients. Compared to IV route, IC abciximab was associated with a significant reduction in mortality (odds ratio, OR [95% confidence interval (CI)]=0.43 [0.20-0.94], p=0.03), and TVR (OR [95% CI]=0.53 [0.29-0.99], p=0.05). No differences in terms of recurrent myocardial infarction (OR [95% CI]=0.54 [0.23-1.28], p=0.17) or major bleeding complications (OR [95% CI]=0.91 [0.46-1.79], p=0.79) were observed between the two strategies. The present meta-analysis showed that IC administration of abciximab is associated with significant benefits in mortality at short-term follow-up compared to IV abciximab administration, without any excess of major bleeding in STEMI patients undergoing PPCI. However, further trials are warranted to establish the optimal strategy of abciximab treatment in this setting.

Original languageEnglish (US)
Pages (from-to)274-281
Number of pages8
JournalPlatelets
Volume23
Issue number4
DOIs
StatePublished - Jun 1 2012

Keywords

  • Abciximab
  • Primary angioplasty
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Hematology

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