title: Intracoronary compared to intravenous bolus abciximab during primary percutaneous coronary intervention in ST-segment Elevation Myocardial Infarction (STEMI) patients reduces 30-day mortality and target vessel revascularization: a randomized trial.
abstract: BACKGROUND
  Abciximab is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, the optimal administration route of the initial bolus of abciximab, that is, intravenous (IV) versus intracoronary (IC), has been questioned. Preliminary studies suggest that IC-bolus is superior, probably due to high local concentration. In this study, we assess the short-term efficacy and safety of IC compared to IV bolus of abciximab in patients with STEMI during pPCI.
  
  
  METHODS
  In 2006-2008, we randomized 355 STEMI patients who underwent pPCI and had indication for abciximab to either IV or IC bolus followed by a 12-hour IV infusion. Primary end-points at 30 days were target vessel revascularization (TVR), recurrent myocardial infarction (MI) or death, and the composite of the three. Secondary end-points were bleeding complications.
  
  
  RESULTS
  The two groups (IV n = 170;IC n = 185) were similar with respect to baseline characteristics. Mortality at 30 days was 5.3% in the IV group compared to only 1.1% in the IC group (P = 0.02). TVR was performed in 9.4% in the IV group compared to 3.8% in the IC group (P = 0.03). No significant difference in MI rates was seen (IV 4.7% vs. IC 2.7%; P = 0.32). We found a significant reduction in the composite end-point (IV 19.4% vs. IC 7.6%; P = 0.001) in favor of IC use. Major bleeding complications were similar (IV 2.4% vs. IC 1.6%; P = 0.62). Neither difference was observed in minor bleedings (IV 14.1% vs. IC 9.7%; P = 0.20).
  
  
  CONCLUSIONS
  IC administration of bolus abciximab in STEMI patients undergoing pPCI reduces 30-day mortality and TVR and tends to reduce MI, compared to IV-bolus.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. allive01@geh.regionh.dk
authors.forename: Allan
authors.initials: A
authors.lastname: Iversen
authors.forename: Ulrik
authors.initials: U
authors.lastname: Abildgaard
authors.forename: Anders
authors.initials: A
authors.lastname: Galloe
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.forename: Soren
authors.initials: S
authors.lastname: Galatius
authors.forename: Jan K
authors.initials: JK
authors.lastname: Madsen
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstroem
authors.forename: Sune
authors.initials: S
authors.lastname: Pedersen
authors.forename: Kurt S
authors.initials: KS
authors.lastname: Jensen
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
mesh_terms: D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003331:Coronary Vessels / Q000473:pathology*; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab