Clinical impact of intracoronary abciximab in patients undergoing primary percutaneous coronary intervention: an individual patient data pooled analysis of randomised studies
- Raffaele Piccolo1,
- Youlan L Gu2,
- Allan Zeeberg Iversen3,
- Alberto Dominguez-Rodriguez4,
- Bart J G L de Smet2,
- Karim D Mahmoud2,
- Ingo Eitel5,
- Pedro Abreu-Gonzalez6,
- Holger Thiele5,
- Federico Piscione1
- 1Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy
- 2Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, The Netherlands
- 3Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
- 4Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
- 5Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
- 6Department of Physiology, Universidad de La Laguna, Tenerife, Spain
- Correspondence to Professor Federico Piscione, Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Via S Pansini, 5 80131 Naples, Italy;
Contributors All authors substantially contributed to the production of the manuscript. RP and FP were in charge of the study design and concept. The other authors provided individual patient data and provided a critical revision of the manuscript for important intellectual content.
- Accepted 31 January 2012
- Published Online First 7 March 2012
Objectives The aim of this study was to perform an individual patient-level pooled analysis of randomised trials, comparing intracoronary versus intravenous abciximab bolus use in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Background Abciximab represents a cornerstone in the treatment of STEMI patients undergoing primary PCI. Intracoronary abciximab bolus administration has been proposed as an alternative strategy to the standard intravenous route. However, whether intracoronary abciximab effectively improves clinical outcomes compared with standard route remains unknown.
Methods Individual data of 1198 patients enrolled in five trials were entered into the pooled analysis. The primary endpoint of the study was the occurrence of all-cause death and reinfarction at 30-day follow-up. Secondary endpoints were all-cause death, reinfarction and target-vessel revascularisation (TVR).
Results No significant heterogeneity was found across trials. Compared with the intravenous route, intracoronary abciximab administration significantly reduced the risk of the composite of death and reinfarction (HR 0.52, 95% CI 0.29 to 0.94; p=0.03), death (HR 0.44, 95% CI 0.20 to 0.95; p=0.04) and TVR (HR 0.53, 95% CI 0.29 to 0.99; p=0.045), without a significant impact on the risk of reinfarction (HR 0.54, 95% CI 0.24 to 1.21; p=0.13). However, after correction for baseline differences, only the composite of death/reinfarction and death remained significant.
Conclusions In STEMI patients undergoing primary PCI, intracoronary abciximab administration, when compared with the intravenous standard route, can improve short-term clinical outcomes mainly by reducing the risk of death.
- Acute coronary syndrome
- acute myocardial infarction
- cardiac function
- circadian rhythm
- coronary angiography
- coronary intervention
- glycoprotein IIb/IIIa receptor antagonists
- interventional cardiology
- intracoronary abciximab
- myocardial disease
- myocardial ischaemia and infarction (IHD)
- myocardial perfusion
- myocardial viability
- non-coronary intervention
- primary percutaneous coronary intervention
Funding HT received an unrestricted research grant and minor speaker honoraria from Lilly, Germany.
Correction notice This article has been corrected since it was published Online First. Dr Bertrand has respectfully requested that his name be retracted from the list of co-authors.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.