open access

Vol 19, No 3 (2012)
Review paper
Published online: 2012-05-28
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Updated evidence on intracoronary abciximab in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized clinical trials

Jacek Kubica, Marek Koziński, Eliano P. Navarese, Udaya S. Tantry, Grzegorz Grześk, Tomasz Fabiszak, Aldona Kubica, Iwona Świątkiewicz, Kevin P. Bliden, Paul A. Gurbel
Cardiol J 2012;19(3):230-242.

open access

Vol 19, No 3 (2012)
Review articles
Published online: 2012-05-28

Abstract

Background: Intracoronary (IC) abciximab administration remains a promising approach aimed to increase a drug concentration in the target area and possibly improve clinical outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of this literature review and meta-analysis is to update available knowledge comparing IC and intravenous (IV) abciximab administration in STEMI patients.
Methods: A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and major bleeding complications were the secondary end points.
Results: IC abciximab did not provide any benefits in terms of all-cause mortality as compared with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.34–1.34). However, this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40–0.92) but the difference disappeared after one of the RCTs was excluded from the analysis. Both strategies were equal regarding TVR (OR 0.66; 95% CI 0.40–1.09) and major bleeding complications (OR 1.18; 95% CI 0.76–1.83).
Conclusions: Our updated meta-analysis shows that the clinical superiority of IC over IV abciximab administration in STEMI patients is no longer clear after the release of the AIDA STEMI trial results. Further research in high-risk STEMI patients is warranted to finally determine clinical advantages of IC vs IV abciximab administration.

Abstract

Background: Intracoronary (IC) abciximab administration remains a promising approach aimed to increase a drug concentration in the target area and possibly improve clinical outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of this literature review and meta-analysis is to update available knowledge comparing IC and intravenous (IV) abciximab administration in STEMI patients.
Methods: A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and major bleeding complications were the secondary end points.
Results: IC abciximab did not provide any benefits in terms of all-cause mortality as compared with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.34–1.34). However, this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40–0.92) but the difference disappeared after one of the RCTs was excluded from the analysis. Both strategies were equal regarding TVR (OR 0.66; 95% CI 0.40–1.09) and major bleeding complications (OR 1.18; 95% CI 0.76–1.83).
Conclusions: Our updated meta-analysis shows that the clinical superiority of IC over IV abciximab administration in STEMI patients is no longer clear after the release of the AIDA STEMI trial results. Further research in high-risk STEMI patients is warranted to finally determine clinical advantages of IC vs IV abciximab administration.
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Keywords

intracoronary abciximab; myocardial infarction; primary PCI

About this article
Title

Updated evidence on intracoronary abciximab in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized clinical trials

Journal

Cardiology Journal

Issue

Vol 19, No 3 (2012)

Article type

Review paper

Pages

230-242

Published online

2012-05-28

Bibliographic record

Cardiol J 2012;19(3):230-242.

Keywords

intracoronary abciximab
myocardial infarction
primary PCI

Authors

Jacek Kubica
Marek Koziński
Eliano P. Navarese
Udaya S. Tantry
Grzegorz Grześk
Tomasz Fabiszak
Aldona Kubica
Iwona Świątkiewicz
Kevin P. Bliden
Paul A. Gurbel

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