Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty: a meta-analysis of 8 randomized trials.

Abstract

BACKGROUND:

Adjunctive abciximab administration has been demonstrated 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 IV route. Therefore, the aim of the current study was to perform a meta-analysis of randomized trials (RCTs) to assess the clinical efficacy and safety of IC vs IV abciximab administration in STEMI patients undergoing primary angioplasty.

METHODS:

We obtained results from all RCTs enrolling STEMI patients undergoing primary percutaneous coronary intervention (PCI). The primary endpoint was mortality, while recurrent myocardial infarction, postprocedural epicardial (TIMI 3) and myocardial (MBG 2-3) perfusion were identified as secondary endpoints. The safety endpoint was the risk of major bleeding complications.

RESULTS:

A total of 8 randomized trials were finally included in the meta-analysis, enrolling a total of 3259 patients. As compared to IV route, IC abciximab was associated with a significant improvement in myocardial perfusion (OR [95% CI]=1.76 [1.28-2.42], p<0.001), without significant benefits in terms of mortality (OR [95% CI]=0.85 [0.59-1.23], p=0.39), reinfarction (OR [95% CI]=0.79 [0.46-1.33], p=0.37), or major bleeding complications (OR [95% CI]=1.19 [0.76-1.87], p=0.44). However, we observed a significant relationship between patient's risk profile and mortality benefits from IC abciximab administration (p=0.011).

CONCLUSIONS:

The present updated meta-analysis showed that IC administration of abciximab is associated with significant benefits in myocardial perfusion, but not in clinical outcome at short-term follow-up as compared to IV abciximab administration, without any excess of major bleedings in STEMI patients undergoing primary PCI. However, a significant relationship was observed between patient's risk profile and mortality benefits from IC abciximab administration. Therefore, waiting for long-term follow-up results and additional randomized trials, IC abciximab administration cannot be routinely recommended, but may be considered in high-risk patients.

• Authors: Giuseppe De Luca, Monica Verdoia, Harry Suryapranata
• Journal: Atherosclerosis (Atherosclerosis) Vol. 222 Issue 2 Pg. 426-33 (Jun 2012) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 22483166 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Abciximab

Topics

• Abciximab
• Angioplasty, Balloon, Coronary (adverse effects, mortality)
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Coronary Circulation (drug effects)
• Coronary Vessels
• Evidence-Based Medicine
• Hemorrhage (chemically induced)
• Humans
• Immunoglobulin Fab Fragments (administration & dosage, adverse effects)
• Infusions, Intravenous
• Injections, Intra-Arterial
• Injections, Intravenous
• Myocardial Infarction (mortality, physiopathology, therapy)
• Odds Ratio
• Patient Selection
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Randomized Controlled Trials as Topic
• Regression Analysis
• Risk Assessment
• Risk Factors
• Secondary Prevention
• Time Factors
• Treatment Outcome