title: Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous Coronary Revascularization for Acute ST-Elevation Myocardial Infarction.
abstract: Cigarette smokers with ST-segment elevation myocardial infarction (STEMI) may present different response to potent antithrombotic therapy compared to nonsmokers. We assessed the impact of smoking status and intracoronary abciximab in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We pooled data from 5 randomized trials comparing intracoronary versus intravenous abciximab bolus in patients undergoing primary PCI. The primary end point was the composite of death or reinfarction at a mean follow-up of 292 ± 138 days. Of 3,158 participants, 1,369 (43.3%) were smokers, and they had a lower risk of the primary end point in crude, but not in adjusted analyses (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.63 to 1.21, p = 0.405). Intracoronary versus intravenous abciximab was associated with a significant reduction in the risk of primary end point among smokers (3.6% vs 8.0%; HR 0.43, 95% CI 0.26 to 0.72, p = 0.001), but not in nonsmokers (10.2% vs 9.9%; HR 0.99, 95% CI 0.72 to 1.36, p = 0.96), with a significant interaction (p = 0.009). Furthermore, intracoronary abciximab decreased the risk of reinfarction in smokers (HR 0.30, 95% CI 0.15 to 0.62, p = 0.001), with no difference in nonsmokers (HR 1.20, 95% CI 0.71 to 2.01, p = 0.50). Stent thrombosis was lowered by intracoronary abciximab in smokers (HR 0.28, 95% CI 0.06 to 0.66, p = 0.009), but was ineffective in nonsmokers (HR 1.04, 95% CI 0.54 to 2.00, p = 0.903). Interaction testing showed heterogeneity in treatment effect for reinfarction (p = 0.002) and stent thrombosis (p = 0.018) according to smoking status. In conclusion, among patients with STEMI undergoing primary PCI, smoking status did not affect the adjusted risk of clinical events. Intracoronary abciximab bolus improved clinical outcomes by reducing the risk of death or reinfarction.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: Raffaele.Piccolo@insel.ch.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Hospital Universitario de Canarias, Facultad de Ciencias de la Salud, Department of Cardiology, Universidad Europea de Canarias Tenerife, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dominguez-Rodriguez
authors.affiliation: Department of Cardiology, Rigshospitalet, 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 Physiology, Universidad de La Laguna, Tenerife, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu-Gonzalez
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: Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: University Heart Center Lübeck, 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.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D000077284:Abciximab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D012907:Smoking / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab