Intracoronary administration of abciximab appears superior to intravenous administration in STEMI patients, improving surrogate endpoints such as infarct size and ST-segment resolution.
Systematic Review
Does intracoronary (IC) abciximab administration improve outcomes compared to intravenous (IV) administration in patients with STEMI undergoing primary PCI?
Intracoronary administration of abciximab in STEMI patients appears superior to intravenous administration for surrogate endpoints, but adequately powered multicenter randomized trials are needed to confirm clinical benefits.
OBJECTIVES: To perform a systematic review to provide rationale for intracoronary (IC) abciximab administration in patients with ST-segment elevation myocardial infarction (STEMI), to summarize recent studies comparing IC vs. intravenous (IV) abciximab administration in this setting and to define questions that need to be answered in future trials determining the optimal abciximab regimen. METHODS: A search covering the period from January 1993 to June 2011 was conducted by two independent investigators using MEDLINE, CENTRAL and Google Scholar databases. Proceedings from the scientific sessions of ACC, AHA, ESC, TCT and EuroPCR were also considered. RESULTS: IC administration allows one to obtain a much higher concentration of abciximab than IV injection at the culprit lesion. Therefore it is hypothesized that IC abciximab administration provides more efficient GP IIb/IIIa receptor inhibition and more pronounced additional dose-dependent antiplatelet, antithrombotic, and anti-inflammatory effects when compared to the IV route. Numerous observational and randomized studies comparing IC vs. IV abciximab in STEMI patients indicated improvement in different surrogate end points (infarct size, obstruction of coronary microcirculation, ST segment resolution, inflammatory mediators and markers of platelet activation) related to IC administration. The evidence supporting clinical benefits associated with IC injection of abciximab comes from one randomized and several non-randomized trials as most of the studies were underpowered to assess clinical outcomes. No difference in bleeding complications was observed between IC and IV regimens. Issues that need to be addressed in future studies include: the use of IC abciximab in combination with thrombectomy, the role of selective delivery systems, and the necessity of a prolonged IV infusion of abciximab after IC bolus administration. CONCLUSIONS: An accumulating body of evidence suggests the superiority of IC over IV abciximab administration in STEMI patients. However, further trials are warranted to establish the optimal strategy of abciximab treatment in this setting.
Kubica et al. (Mon,) conducted a systematic review in ST-segment elevation myocardial infarction (STEMI). Intracoronary abciximab vs. Intravenous abciximab was evaluated. Intracoronary administration of abciximab appears superior to intravenous administration in STEMI patients, improving surrogate endpoints such as infarct size and ST-segment resolution.