Abstrakt:
Abstract
Background: Intracoronary (IC) abciximab administration remains a promising approach
aimed to increase a drug concentration in the target area and possibly improve clinical
outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of
this literature review and meta-analysis is to update available knowledge comparing IC and
intravenous (IV) abciximab administration in STEMI patients.
Methods: A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months
were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary
end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR)
and major bleeding complications were the secondary end points.
Results: IC abciximab did not provide any benefits in terms of all-cause mortality as compared
with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.34 1.34). However,
this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a
reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40 0.92)
but the difference disappeared after one of the RCTs was excluded from the analysis. Both
strategies were equal regarding TVR (OR 0.66; 95% CI 0.40 1.09) and major bleeding
complications (OR 1.18; 95% CI 0.76 1.83).
Conclusions: Our updated meta-analysis shows that the clinical superiority of IC over IV
abciximab administration in STEMI patients is no longer clear after the release of the AIDA
STEMI trial results. Further research in high-risk STEMI patients is warranted to finally
determine clinical advantages of IC vs IV abciximab administration. (Cardiol J 2012; 19, 3:230 242)
