Intracoronary application of abciximab in patients with ST-elevation myocardial infarction
Jochen Wöhrle1, Thorsten Nusser, Christine Mayer
1Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Insights
Intracoronary abciximab bolus administration during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is safe. This method is linked to a low rate of major adverse cardiac events (MACE) within 30 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Abciximab exhibits dose-dependent antiplatelet and anti-inflammatory effects.
- Prospective studies evaluating intracoronary abciximab bolus in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) are lacking.
Purpose of the Study:
- To assess the safety and efficacy of intracoronary abciximab bolus administration in STEMI patients undergoing primary PCI.
- To evaluate the rate of major adverse cardiac events (MACE) and bleeding complications.
Main Methods:
- A prospective observational study enrolled 633 STEMI patients.
- Intracoronary filtered abciximab bolus (2,000 microg/mL) was administered, followed by a 12-hour intravenous infusion.
- Patients were divided into two groups based on specific clinical criteria; Group I received intracoronary abciximab, and outcomes were compared to historical data of intravenous administration.
Main Results:
- No safety issues were reported with intracoronary abciximab administration.
- Group I (intracoronary abciximab) showed significantly lower rates of MACE (3.6%) and major TIMI bleeding (2.0%) compared to Group II (p<0.0001).
- Predictors of MACE included assignment to Group II, post-PCI TIMI flow of 0-2, and female gender.
Conclusions:
- Intracoronary abciximab bolus administration during PCI in STEMI patients is a safe procedure.
- This approach is associated with a low 30-day rate of major adverse cardiac events (MACE).
Aims:
Abciximab provides dose-dependent antiplatelet and anti-inflammatory properties. No specifically designed prospective studies have addressed the role of intracoronary bolus administration of abciximab in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Methods And Results:
In a prospective observational study 633 STEMI patients were enrolled. After coronary angiography the filtered abciximab bolus with a concentration of 2,000 microg/mL was administered intracoronary by manual injection, followed by an intravenous infusion for 12 hours. Primary outcome measure was the cumulative rate of major adverse cardiac events (MACE) at 30 days defined as death, myocardial infarction or urgent target vessel revascularisation. Bleeding events were classified according to TIMI criteria. Patients with failed thrombolysis, cardiopulmonary resuscitation, cardiogenic shock, advanced age, or renal failure were assigned to group II; patients without those criteria were assigned to group I and compared to previous populations with intravenous bolus administration. There were no safety issues. In group I MACE occurred in 3.6% (N=16/451), major TIMI bleed in 2.0%. MACE and bleeding events were significantly less frequent in group I compared to group II (both p<0.0001). Significant predictors for MACE in multivariate statistics were assignment to group II (OR 11.69; 95%-CI 6.26-21.83; p<0.0001), post PCI TIMI 0-2 flow (OR 3.87; 95%-CI 2.02-7.44; p<0.0001) and female gender (OR 2.05; 95%-CI 1.15-3.65, p=0.014).
Conclusions:
The intracoronary administration of the abciximab bolus during PCI in STEMI patients is safe and associated with a low rate of MACE at 30 days.
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