title: Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial.
abstract: BACKGROUND
  administration of the glycoprotein IIb/IIIa inhibitor abciximab is an effective adjunctive treatment strategy during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Although small-scale studies have suggested beneficial effects of intracoronary over intravenous administration of abciximab, this has not been investigated in a medium-scale randomized clinical trial.
  
  
  RESULTS
  a total of 534 ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with thrombus aspiration within 12 hours of symptom onset were randomized to either an intracoronary or an intravenous bolus of abciximab (0.25 mg/kg). Patients were pretreated with aspirin, heparin, and clopidogrel. The primary end point was the incidence of restored myocardial reperfusion, defined as complete ST-segment resolution. Secondary end points included myocardial reperfusion as assessed by myocardial blush grade, enzymatic infarct size, and major adverse cardiac events at 30 days. The incidence of complete ST-segment resolution was similar in the intracoronary and intravenous groups (64% versus 62%; P=0.562). However, the incidence of myocardial blush grade 2/3 was higher in the intracoronary group than in the intravenous group (76% versus 67%; P=0.022). Furthermore, enzymatic infarct size was smaller in the intracoronary than in the intravenous group (P=0.008). The incidence of major adverse cardiac events was similar in both groups (5.5% versus 6.1%; P=0.786).
  
  
  CONCLUSIONS
  in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with thrombus aspiration, intracoronary administration of abciximab compared with intravenous administration does not improve myocardial reperfusion as assessed by ST-segment resolution. However, intracoronary administration is associated with improved myocardial reperfusion as assessed by myocardial blush grade and a smaller enzymatic infarct size.
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001 9700 RB Groningen, Netherlands. y.l.gu@thorax.umcg.nl
authors.forename: Youlan L
authors.initials: YL
authors.lastname: Gu
authors.forename: Marthe A
authors.initials: MA
authors.lastname: Kampinga
authors.forename: Wouter G
authors.initials: WG
authors.lastname: Wieringa
authors.forename: Marieke L
authors.initials: ML
authors.lastname: Fokkema
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Nijsten
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Ad F M
authors.initials: AF
authors.lastname: van den Heuvel
authors.forename: Eng-Shiong
authors.initials: ES
authors.lastname: Tan
authors.forename: Gabija
authors.initials: G
authors.lastname: Pundziute
authors.forename: Rik
authors.initials: R
authors.lastname: van der Werf
authors.forename: Siyrous
authors.initials: S
authors.lastname: Hoseyni Guyomi
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Bart J G L
authors.initials: BJ
authors.lastname: de Smet
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003331:Coronary Vessels; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D013396:Suction; D013927:Thrombosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab