Intracoronary Reopro during Percutaneous Coronary Intervention in Acute and Stable Patient can Influence Stent Thrombosis Formation (IRPASST) Study
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Published on: May 14, 2013
Mohammed Balghith1, Ali Al-Ghamdi, El Harif Zain
1King Saud Bin Abdulaziz University for Health Sciences, KACC, National Guard, Riyadh, Kingdom of Saudi Arabia.
Insights
Intracoronary abciximab bolus showed a trend towards reducing stent thrombosis and target vessel revascularization compared to intravenous administration. Further randomized trials are needed to confirm these findings for acute coronary syndromes and stable coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Abciximab reduces major adverse cardiac events in patients with acute myocardial infarction or unstable angina undergoing angioplasty.
- Intravenous administration is most commonly studied, but intracoronary (IC) bolus may offer superior local drug concentrations.
- High local concentrations from IC abciximab might reduce acute and sub-acute stent thrombosis (ST).
Purpose of the Study:
- To evaluate if IC bolus abciximab reduces ST and target vessel revascularization (TVR).
- To compare the efficacy of IC bolus versus standard intravenous (IV) administration of abciximab in reducing major adverse cardiac events (MACE).
Main Methods:
- Single-center observational study of 447 patients undergoing percutaneous coronary intervention (PCI) and stenting.
- Group I (n=199) received IC bolus abciximab (0.25 μg/kg).
- Group II (n=248) received standard IV abciximab (0.25 μg/kg bolus, 0.125 μg/kg/h infusion for 12h).
Main Results:
- No significant differences in diabetes mellitus, acute coronary syndrome (ACS), drug-eluting stent (DES), or bare metal stent (BMS) usage between groups.
- TVR occurred in 4% of the IC group vs. 6% of the IV group (P=0.093).
- ST occurred in 2% of the IC group vs. 2.8% of the IV group (P=0.056).
Conclusions:
- A trend towards reduced ST and TVR was observed with IC abciximab compared to IV administration.
- In-stent restenosis was lower in the IC group, particularly with BMS usage.
- Randomized controlled trials are necessary to definitively assess the benefits of IC abciximab in reducing ST.
Background:
In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events (MACE). Most clinical trials have studied mainly intravenous administration. Intracoronary (IC) bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis (ST). We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization (TVR); therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application.
Materials And Methods:
This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention (PCI) and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups: Group I (n = 199) patient received IC bolus of abciximab (reopro) 0.25 μg/kg during the PCI in cath lab. Group II (n = 248) received the standard dose of reopro-a bolus intravenous 0.25 μg/kg and maintenance dose of 0.125 μg/kg over 12 h.
Results:
There were no differences between the groups with regard to diabetes mellitus, group I (56%) vs. group II (58%), P = 0.613; ACS, group I (38%) vs. group II (44%), P = 0.175; Dietthylstilbestrol Drug eluted stent (DES) in group I (66.5%) vs. (57.6%) group II, P = 0.056; Bare Metal Stent (BMS) in group I (33%) vs. (40.7%) group II, P=0.093; target vessel revascularization (TRV) was seen in 9 patients (4%) in group I vs. 16 patients (6%) in group II. ST elevation was seen in 4 patients (2%) in group I vs. 7 patients (2.8%) in group II, all presented with STEMI.
Conclusion:
In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups (56%), especially in Saudi patients. In-stent restenosis (ISR) was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST.
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