Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty: A meta-analysis of 8 randomized trials
Luca GD et al. – The present updated meta–analysis showed that IC administration of abciximab is associated with significant benefits in myocardial perfusion, but not in clinical outcome at short–term follow–up as compared to IV abciximab administration, without any excess of major bleedings in STEMI patients undergoing primary PCI. However, a significant relationship was observed between patient's risk profile and mortality benefits from IC abciximab administration. Therefore, waiting for long–term follow–up results and additional randomized trials, IC abciximab administration cannot be routinely recommended, but may be considered in high–risk patients.Methods
- Authors obtained results from all RCTs enrolling STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- The primary endpoint was mortality, while recurrent myocardial infarction, postprocedural epicardial (TIMI 3) and myocardial (MBG 2–3) perfusion were identified as secondary endpoints.
- The safety endpoint was the risk of major bleeding complications.
- A total of 8 randomized trials were finally included in the meta–analysis, enrolling a total of 3259 patients.
- As compared to IV route, IC abciximab was associated with a significant improvement in myocardial perfusion (OR [95% CI]=1.76 [1.28–2.42], p<0.001), without significant benefits in terms of mortality (OR [95% CI]=0.85 [0.59–1.23], p=0.39), reinfarction (OR [95% CI]=0.79 [0.46–1.33], p=0.37), or major bleeding complications (OR [95% CI]=1.19 [0.76–1.87], p=0.44).
- However, authors observed a significant relationship between patient's risk profile and mortality benefits from IC abciximab administration (p=0.011).