Intracoronary application of abciximab in patients with ST-elevation myocardial infarction.
OBJECTIVE
Abciximab provides dose-dependent antiplatelet and anti-inflammatory properties. No specifically designed prospective studies have addressed the role of intracoronary bolus administration of abciximab in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


RESULTS
In a prospective observational study 633 STEMI patients were enrolled. After coronary angiography the filtered abciximab bolus with a concentration of 2,000 microg/mL was administered intracoronary by manual injection, followed by an intravenous infusion for 12 hours. Primary outcome measure was the cumulative rate of major adverse cardiac events (MACE) at 30 days defined as death, myocardial infarction or urgent target vessel revascularisation. Bleeding events were classified according to TIMI criteria. Patients with failed thrombolysis, cardiopulmonary resuscitation, cardiogenic shock, advanced age, or renal failure were assigned to group II; patients without those criteria were assigned to group I and compared to previous populations with intravenous bolus administration. There were no safety issues. In group I MACE occurred in 3.6% (N=16/451), major TIMI bleed in 2.0%. MACE and bleeding events were significantly less frequent in group I compared to group II (both p<0.0001). Significant predictors for MACE in multivariate statistics were assignment to group II (OR 11.69; 95%-CI 6.26-21.83; p<0.0001), post PCI TIMI 0-2 flow (OR 3.87; 95%-CI 2.02-7.44; p<0.0001) and female gender (OR 2.05; 95%-CI 1.15-3.65, p=0.014).


CONCLUSIONS
The intracoronary administration of the abciximab bolus during PCI in STEMI patients is safe and associated with a low rate of MACE at 30 days.
Wöhrle
Jochen
J
Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Nusser
Thorsten
T
Mayer
Christine
C
Kochs
Matthias
M
Hombach
Vinzenz
V