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Intracoronary Abciximab Limits MACE During Emergent PCI

Patient outcomes were affected by how the initial abciximab bolus was administered.

In patients with acute coronary syndromes, including MI, the benefits of platelet inhibition with abciximab during percutaneous coronary intervention (PCI) are well established. In this retrospective, single-center German study of abciximab during PCI, investigators compared intracoronary administration (294 patients) with intravenous administration (109 patients) of the initial 20-mg bolus. In both groups, the bolus was followed by 12-hour IV infusion of abciximab (10 mg).

Baseline clinical and angiographic variables were similar in the 2 groups: About 75% had acute MI, the rest unstable angina; 14%-18% had cardiogenic shock. The intracoronary and IV groups also had similar TIMI flow before the intervention (grade, 0.8 and 0.9, respectively) and after it (grade, 2.8 in both groups).

Stent use was significantly more common in the intracoronary group (73%) than in the IV group (59%), so the former had significantly greater acute gain of minimal lumen diameter (2.42 mm vs. 2.15 mm). By 30 days, the incidence of major adverse cardiac events (MACE; death, recurrent MI, or urgent revascularization) was lower in the intracoronary group (10.2% vs. 20.2%, P<0.0008). Most of the mortality in both groups was related to cardiogenic shock; among patients without shock, mortality incidence was significantly lower with intracoronary (2%) than with IV (9%) abciximab. Intracoronary administration's greatest benefit was in patients with preprocedural TIMI grade 0-1 flow (MACE incidence in the TIMI 0-1 subgroup: 11.8%, intracoronary; 27.5%, IV).

Comment: In this study, intracoronary abciximab administration during emergent PCI markedly limited MACE in patients with preprocedural TIMI 0-1 flow. The abciximab dose used, though not weight-adjusted, is typical for an 80-kg patient. The authors speculate that high local doses of abciximab facilitated diffusion of the antibody to platelets inside flow-limiting thrombi. We need a prospective, randomized trial to confirm this study's findings.

— Howard C. Herrmann, MD

Published in Journal Watch Cardiology May 23, 2003

Citation(s):

Wöhrle J et al. Reduction of major adverse cardiac events with intracoronary compared with intravenous bolus application of abciximab in patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty. Circulation 2003 Apr 15; 107:1840-3.

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