title: 1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention.
abstract: Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.
  
  
  
  This study sought to report the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary PCI.
  
  
  
  Patient-level data from 3 randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in 1 study.
  
  
  
  Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs. 17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR: 0.95; 95% CI: 0.68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08 to 0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4; interquartile range: 35.1 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p = 0.011; p for interaction vs. no diabetes = 0.016).
  
  
  
  In diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus.
authors: Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: Raffaele.Piccolo@insel.ch.
authors: Raffaele
authors: R
authors: Piccolo
authors: University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors: Ingo
authors: I
authors: Eitel
authors: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors: Gennaro
authors: G
authors: Galasso
authors: Hospital Universitario de Canarias, Facultad de Ciencias de la Salud, Universidad Europea de Canarias Tenerife, Spain.
authors: Alberto
authors: A
authors: Dominguez-Rodriguez
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Allan Zeeberg
authors: AZ
authors: Iversen
authors: Department of Physiology, Universidad de La Laguna, Tenerife, Spain.
authors: Pedro
authors: P
authors: Abreu-Gonzalez
authors: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors: Stephan
authors: S
authors: Windecker
authors: University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors: Holger
authors: H
authors: Thiele
authors: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors: Federico
authors: F
authors: Piscione
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003331:Coronary Vessels; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007269:Injections, Intra-Arterial; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab
keywords: STEMI; diabetes mellitus; myocardial infarction; myocardial revascularization