1. Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
- Author
-
Piccolo R, Eitel I, Galasso G, Iversen AZ, Gu YL, Dominguez-Rodriguez A, de Smet BJ, Mahmoud KD, Abreu-Gonzalez P, Thiele H, and Piscione F
- Subjects
- Abciximab, Administration, Intravenous, Aged, Antibodies, Monoclonal adverse effects, Chi-Square Distribution, Coronary Thrombosis etiology, Coronary Thrombosis prevention & control, Female, Humans, Immunoglobulin Fab Fragments adverse effects, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Odds Ratio, Platelet Aggregation Inhibitors adverse effects, Proportional Hazards Models, Randomized Controlled Trials as Topic, Recurrence, Risk Factors, Time Factors, Treatment Outcome, Antibodies, Monoclonal administration & dosage, Diabetes Mellitus diagnosis, Diabetes Mellitus mortality, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Platelet Aggregation Inhibitors administration & dosage
- Abstract
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., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF