title: Intracoronary abciximab reduces death and major adverse cardiovascular events in acute coronary syndromes: a meta-analysis of clinical trials.
abstract: BACKGROUND
  Successful reperfusion of epicardial coronary arteries does not necessarily result in actual myocardial perfusion. Local intracoronary (IC) delivery of GP IIb/IIIa inhibitors (GPI) has been proposed to achieve further clinical efficacy when compared to standard intravenous (IV) administration. However clinical trials have shown conflicting results. The aim of the present study was to compare IC with IV abciximab administration on mortality and MACEs in patients with ACS undergoing PCI.
  
  
  METHODS
  We performed a meta-analysis of all available clinical trials comparing intracoronary versus intravenous abciximab administration.
  
  
  RESULTS
  At short-term analysis, incidence of MACEs was significantly lower in the IC group than in the IV group (OR=0.56; 95% CI 0.35-0.89; p=0.015). Interestingly, subgroup analysis showed that most benefit was coming from those studies with a main baseline LVEF<50% (OR=0.33 95% CI 0.18-0.59). Similarly, long-term incidence of MACEs was significantly lower in the IC group than in the IV group (OR=0.47; 95% CI 0.31-0.71; p<0.001), with most benefit coming from those studies enrolling patients with a main baseline EF<50% (OR=0.38 95% CI 0.23-0.63 p<0.001). In addition, long-term incidence of death was also lower in the IC group than in the IV group (OR=0.42; 95% CI 0.20-0.86; p=0.009).
  
  
  CONCLUSIONS
  Our meta-analysis provides evidence of a net clinical benefit for intracoronary versus intravenous abciximab administration, with the highest benefit observed in high-risk ACS patients, such as those with reduced baseline LVEF.
authors.affiliation: Division of Cardiology, "Magna Graecia" University of Catanzaro, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Rosa
authors.forename: Gianluca
authors.initials: G
authors.lastname: Caiazzo
authors.forename: Daniele
authors.initials: D
authors.lastname: Torella
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
mesh_terms: D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D003331:Coronary Vessels / Q000473:pathology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000627:therapeutic use; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab