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1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary
Raffaele Piccolo1, Ingo Eitel2, Gennaro Galasso3
1Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Insights
Intracoronary abciximab bolus significantly reduced cardiovascular events in diabetic patients after ST-segment elevation myocardial infarction (STEMI). This treatment improved outcomes and myocardial salvage compared to intravenous administration.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetology
Background:
- Diabetic patients face higher risks of cardiovascular events post-ST-segment elevation myocardial infarction (STEMI).
- Intracoronary abciximab administration during primary percutaneous coronary intervention (PCI) shows potential benefit in this high-risk group.
Purpose of the Study:
- To evaluate 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings.
- To compare intracoronary versus intravenous abciximab bolus in STEMI patients with and without diabetes undergoing primary PCI.
Main Methods:
- Pooled patient-level data from 3 randomized trials.
- Primary endpoint: composite of death or reinfarction.
- Cardiac magnetic resonance (CMR) imaging in a subset of patients.
Main Results:
- Diabetic patients receiving intracoronary abciximab had a significantly lower primary endpoint rate (9.2% vs. 17.6%; p=0.009).
- No significant benefit observed in non-diabetic patients (7.4% vs. 7.5%; p=0.77), indicating a significant interaction (p=0.034).
- Diabetic patients showed reduced death (p=0.043) and stent thrombosis (p=0.046) with intracoronary abciximab. CMR revealed increased myocardial salvage in diabetic patients receiving intracoronary abciximab (p=0.011).
Conclusions:
- Intracoronary abciximab bolus administration improves outcomes in diabetic patients with STEMI undergoing primary PCI.
- This approach enhances the effectiveness of primary PCI compared to intravenous administration in this specific patient subgroup.
Background:
Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.
Objectives:
This study sought to report the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary PCI.
Methods:
Patient-level data from 3 randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in 1 study.
Results:
Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs. 17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR: 0.95; 95% CI: 0.68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08 to 0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4; interquartile range: 35.1 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p = 0.011; p for interaction vs. no diabetes = 0.016).
Conclusions:
In diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus.
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