| dc.description.abstract |
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 antiinflammatory
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. |
