Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary
Raffaele Piccolo1, Ingo Eitel2, Gennaro Galasso3
1Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Insights
Intracoronary abciximab significantly reduced death or reinfarction in diabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). This route also lowered stent thrombosis compared to intravenous administration.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Intracoronary abciximab has not shown improved prognosis in unselected ST-segment elevation myocardial infarction (STEMI) patients compared to intravenous administration.
- The specific benefit of intracoronary abciximab in diabetic STEMI patients remains largely unknown.
Purpose of the Study:
- To assess the efficacy of intracoronary abciximab in diabetic patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A pooled analysis of five randomized trials involving 3158 STEMI patients was conducted.
- Outcomes were compared between intracoronary and intravenous abciximab, stratified by diabetic status.
- The primary endpoint was the composite of death or reinfarction at 30-day follow-up.
Main Results:
- In 584 diabetic patients, intracoronary abciximab significantly reduced the composite of death or reinfarction (4.7% vs. 8.8%; p=0.04).
- A significant reduction in definite or probable stent thrombosis was observed with intracoronary abciximab (1% vs. 3.5%; p=0.04).
- No significant clinical benefit was observed in non-diabetic STEMI patients.
Conclusions:
- Intracoronary abciximab may enhance clinical outcomes in diabetic STEMI patients undergoing primary PCI compared to intravenous administration.
- Further confirmation through a dedicated randomized trial is warranted.
Background:
Although intracoronary abciximab failed to improve prognosis compared with intravenous route in unselected ST-segment elevation myocardial infarction (STEMI) patients, little is known about the role of intracoronary abciximab in diabetic patients.
Objectives:
To evaluate the efficacy of intracoronary abciximab administration in diabetic patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Methods:
Reperfusional and clinical outcomes of intracoronary abciximab compared with intravenous bolus abciximab according to diabetic status were evaluated in a pooled analysis of five randomized trials including 3158 STEMI patients. The primary clinical endpoint of the study was the composite of death or reinfarction at 30-day follow-up.
Results:
Among 584 diabetic patients (18.5%), the composite of death or reinfarction was significantly reduced with intracoronary abciximab compared to intravenous abciximab (4.7% vs. 8.8%; rate ratio [RR], 0.50; 95% confidence intervals [CI], 0.26-0.99; p=0.04), driven by numerically lower deaths (3.7% vs. 6.4%; RR, 0.56; 95% CI, 0.26-1.20; p=0.13). Moreover, a significant reduction in definite or probable stent thrombosis was observed in patients receiving intracoronary abciximab (1% vs. 3.5%; RR, 0.27; 95% CI, 0.07-0.99; p=0.04). Although formal tests for interaction were not significant, no clinical benefit was apparent in the cohort of STEMI patients without diabetes (n=2574).
Conclusions:
In diabetic patients with STEMI undergoing primary PCI, intracoronary abciximab may improve clinical outcomes as compared with standard intravenous use. These findings require confirmation in a dedicated randomized trial.
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