title: Intracoronary abciximab in diabetic patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Although intracoronary abciximab failed to improve prognosis compared with intravenous route in unselected ST-segment elevation myocardial infarction (STEMI) patients, little is known about the role of intracoronary abciximab in diabetic patients.
  
  
  OBJECTIVE
  To evaluate the efficacy of intracoronary abciximab administration in diabetic patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  Reperfusional and clinical outcomes of intracoronary abciximab compared with intravenous bolus abciximab according to diabetic status were evaluated in a pooled analysis of five randomized trials including 3158 STEMI patients. The primary clinical endpoint of the study was the composite of death or reinfarction at 30-day follow-up.
  
  
  RESULTS
  Among 584 diabetic patients (18.5%), the composite of death or reinfarction was significantly reduced with intracoronary abciximab compared to intravenous abciximab (4.7% vs. 8.8%; rate ratio [RR], 0.50; 95% confidence intervals [CI], 0.26-0.99; p=0.04), driven by numerically lower deaths (3.7% vs. 6.4%; RR, 0.56; 95% CI, 0.26-1.20; p=0.13). Moreover, a significant reduction in definite or probable stent thrombosis was observed in patients receiving intracoronary abciximab (1% vs. 3.5%; RR, 0.27; 95% CI, 0.07-0.99; p=0.04). Although formal tests for interaction were not significant, no clinical benefit was apparent in the cohort of STEMI patients without diabetes (n=2574).
  
  
  CONCLUSIONS
  In diabetic patients with STEMI undergoing primary PCI, intracoronary abciximab may improve clinical outcomes as compared with standard intravenous use. These findings require confirmation in a dedicated randomized trial.
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.affiliation: Heart Center, Department of Internal Medicine, Cardiology, University of Leipzig, Leipzig, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Allan Zeeberg
authors.initials: AZ
authors.lastname: Iversen
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Youlan L
authors.initials: YL
authors.lastname: Gu
authors.affiliation: Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dominguez-Rodriguez
authors.affiliation: Department of Cardiology, Meander Medisch Centrum, Amersfoort, The Netherlands.
authors.forename: Bart J G L
authors.initials: BJ
authors.lastname: de Smet
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Karim D
authors.initials: KD
authors.lastname: Mahmoud
authors.affiliation: Department of Physiology, Universidad de La Laguna, Tenerife, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu-Gonzalez
authors.affiliation: Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy. Electronic address: fpiscione@unisa.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D000077284:Abciximab; D061605:Administration, Intravenous; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab
keywords: Abciximab; Acute myocardial infarction; Intracoronary administration