Key result
Intracoronary Abciximab during primary PCI resulted in similar postprocedural CRP (2.28 vs. 2.16 mg/dl; P=0.69), ICAM-1, and VCAM-1 levels compared to intravenous administration.
Why the study?
Does intracoronary abciximab improve anti-inflammatory effects compared to intravenous abciximab in STEMI patients undergoing primary PCI?
RCT (n=89)
randomized
Does intracoronary abciximab improve anti-inflammatory effects compared to intravenous abciximab in STEMI patients undergoing primary PCI?
Intracoronary administration of abciximab during primary PCI does not provide additional anti-inflammatory benefits over intravenous administration in STEMI patients.
Intracoronary abciximab yields no greater reduction in inflammatory markers than intravenous during primary PCI; confirms route equivalence for this endpoint in STEMI.
BACKGROUND: Intracoronary Abciximab administration during primary percutaneous coronary intervention (pPCI) could offer theoretical advantages over the intravenous route. Besides antiplatelet effects, Abciximab can modulate inflammation via cross-reactivity with GPIIb/IIIa, avb3, and aMb2 receptors. The aim of our study was to assess whether the Abciximab administration route could influence its anti-inflammatory effects. METHODS: Eighty-nine consecutive ST elevation myocardial infarction patient candidates for pPCI were randomized to intracoronary (Group A-47 patients) or intravenous (Group B-42 patients) Abciximab bolus administration. The primary endpoint was the extent of inflammation, measured by C-reactive protein (CRP), vascular cell adhesion molecule 1 (VCAM-1) and inter-cellular adhesion molecule 1 (ICAM-1) levels. This study is registered with ClinicalTrials.gov, NCT01757457. RESULTS: Data are expressed in medians (interquartiles). In both groups, troponin levels were similar [baseline: 0.12 (0.03-0.94) vs. 0.27 (0.07-1.24) ng/ml, P = 0.73; postprocedural: 22.00 (14.75-69.43) vs. 31.96 (8.23-7.20) ng/ml, P = 0.83]. Both groups also showed similar baseline [0.31 (0.14-0.69) vs. 0.22 (0.09-0.59) mg/ml, P = 0.80] and postprocedural CRP levels [2.28 (1.37-4.23) vs. 2.16 (1.15-3.22) mg/dl, P = 0.69], similar baseline [272.5 (224.7-340.8) vs. 262.2 (221.2-306.4) ng/ml, P = 0.33] and postprocedural soluble ICAM-1 levels [281.5 (244.6-337.4) vs. 287.2 (226.9-359.2) ng/ml P = 0.71], and similar baseline [771.6 (620.9-971.0) vs. 748.6 (592.2-838.8) ng/ml, P = 0.30] and postprocedural soluble VCAM-1 levels [785.2 (671.6-947.1) vs. 745.9 (641.1-841.9) ng/ml, P = 0.17]. In-hospital and 6-month event rates were similar in the two groups. CONCLUSIONS: Our study suggests that Abciximab has similar anti-inflammatory effects irrespective of the administration route. It is unlikely that the potential clinical benefits of intracoronary Abciximab can be related to modulation of integrin receptors.
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Secco et al. (2014) conducted an RCT in ST elevation myocardial infarction (n=89). Intracoronary Abciximab vs. Intravenous Abciximab was evaluated on Extent of inflammation, measured by C-reactive protein (CRP), vascular cell adhesion molecule 1 (VCAM-1) and inter-cellular adhesion molecule 1 (ICAM-1) levels. Intracoronary Abciximab during primary PCI resulted in similar postprocedural CRP (2.28 vs. 2.16 mg/dl; P=0.69), ICAM-1, and VCAM-1 levels compared to intravenous administration.
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