Key result
Intracoronary abciximab bolus only significantly reduced moderate bleeding to 0% compared to 7.2% with standard intravenous bolus plus infusion, with no significant difference in major adverse cardiac events.
Why the study?
Does intracoronary abciximab bolus only reduce bleeding, vascular, ischemic complications, and MACE compared to standard intravenous abciximab protocol in ACS patients undergoing pPCI?
Cohort (n=226)
Does intracoronary abciximab bolus only reduce bleeding, vascular, ischemic complications, and MACE compared to standard intravenous abciximab protocol in ACS patients undergoing pPCI?
Absolute Event Rate: 0% vs 7.2%
p-value: p=0.04
Intracoronary abciximab bolus only may reduce bleeding complications without increasing ischemic events compared to the standard intravenous bolus and infusion protocol in ACS patients undergoing pPCI.
May support intracoronary abciximab bolus-only to limit moderate bleeding in pPCI; hypothesis-generating and requires RCT confirmation.
BACKGROUND: Abciximab reduces major adverse cardiac events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Standard protocol is intravenous abciximab bolus during PCI plus abciximab infusion for 12-18 h post pPCI. Intracoronary (IC) abciximab bolus administration results in high local drug concentrations and hence it should have higher antiplatelet effect. In this study, we assess the short-term efficacy and safety of IC compared to IV bolus of abciximab in ACS patients during pPCI. METHODS: We compared the clinical outcomes between the IC (n = 56) and standard protocol (n = 170) group of patients. Primary endpoints included bleeding/vascular/ischemic complications and MACE. RESULTS: The two groups were similar with respect to baseline characteristics. IC abciximab bolus only reduced bleeding complications, with no moderate bleed versus 7.2% in standard protocol group (p value 0.04). Ischemic/vascular complications had statistically insignificant difference between the two groups. CONCLUSION: We found no significant difference between IC abciximab bolus only and standard abciximab therapy in terms of ischemic/vascular complications and MACE. But there was higher risk of moderate bleed in standard therapy group. The IC bolus route of abciximab may be superior to the intravenous route. Prospective randomized trials are warranted to validate these findings.
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Shakoor et al. (2014) conducted a cohort in Acute coronary syndrome (n=226). Intracoronary abciximab bolus vs. Intravenous abciximab bolus (0.25 mg/kg) plus infusion (0.125 μg/kg/min for 12 h) was evaluated on Moderate bleeding (p=0.04). Intracoronary abciximab bolus only significantly reduced moderate bleeding to 0% compared to 7.2% with standard intravenous bolus plus infusion, with no significant difference in major adverse cardiac events.
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