Despite the introduction of primary angioplasty programmes for patients with acute ST-elevation myocardial infarction (STEMI), up to 70% of patients have impaired myocardial tissue perfusion even after successful treatment.  As intracoronary delivery of abciximab results in much higher concentrations within the coronary artery when compared to intravenous administration, it is logical to propose that this could increase platelet inhibition, displacement of platelet-bound fibrin, and thrombi dissolution, which in turn could decrease distal embolisation and increase myocardial tissue perfusion.n  Should intracoronary injection of abciximab therefore be routine practice during primary percutaneous coronary intervention?

In the Abciximab Intracoronary versus intravenous Drug Application in ST-Elevation Myocardial Infarction (AIDA STEMI) open-label, multicentre trial 1032 patients presenting within 12 hours of STEMI were randomly assigned to receive intracoronary abciximab and 1033 to receive intravenous abciximab. At 90 days after randomisation, the incidence of the primary efficacy endpoint, a composite of all-cause mortality, reinfarction, and new heart failure was similar in the intracoronary group compared with the intravenous group (7.0% vs 7.6%, OR 0.91, 95% CI 0.64–1.28, p=0.58).  However, fewer patients in the intracoronary group had new congestive heart failure (2.4% vs 4.1%; OR 0.57, CI 0.33–0.97, p=0.04) despite similar angiographic appearances and ejection fractions. Bleeding complications did not differ between the two groups and no complications were recorded during intracoronary delivery.  However, a lower than expected event rate in the trial may mean that it was underpowered to detect significant differences between the groups.

Conclusions:

In the setting of primary PCI intracoronary abciximab bolus administration is safe but was not associated with a difference in the combined endpoint of death, reinfarction, or congestive heart failure.

Reference:

1. Thiele H, Wöhrle J, Hambrecht R, Rittger H, Birkemeyer R, Lauer B, Neuhaus P,  Brosteanu O, Sick P, Wiemer M, Kerber S, Kleinertz K, Eitel I, Desch S, Schuler G. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction:  a randomised trial. Lancet. 2012 Feb 20. [Epub ahead of print]