Intracoronary or intravenous abciximab after aspiration thrombectomy in patients with STEMI undergoing primary percutaneous coronary intervention

Abstract

Objectives: To test whether aspiration thrombectomy with intracoronary (IC) instead of intravenous (IV) administration of abciximab could reduce the no-reflow phenomenon in patients undergoing primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI). Background: Despite recanalisation with PCI, failure to restore microvascular flow may affect the prognosis of patients with STEMI. A combination of aspiration thrombectomy with IC abciximab may improve distal perfusion. Methods: After aspiration thrombectomy during primary PCI for STEMI, 160 patients were randomly assigned to either an IV or IC abciximab bolus delivered through the aspiration catheter, both followed by a 12-hour IV abciximab infusion. Results: ST-segment resolution ≥ 70% was achieved in 36 of 78 patients with IC versus 30 of 82 patients with IV abciximab (46.1 vs 36.6%, p = 0.368), and partial resolution in 28 of 78 versus 31 of 82 patients (35.9 vs 37.8%, p = 0.368). Postprocedural myocardial blush grade (MBG) 3 was obtained in 62.8 vs 63.4% (p = 0.235) and MBG ≥ 2 in 89.7 vs 81.7% (p = 0.148) of patients given IC and IV abciximab, respectively. There were three deaths in each group (3.8%). Major adverse cardiac events occurred in six of 78 patients given the IC and seven of 82 patients given the IV abciximab bolus (7.6 vs 8.5%, p = 0.410). One stroke occurred in each group, and two patients in the IC and nine in the IV group developed renal failure (2.5 vs 10.9 %, p = 0.414). Conclusion: IC versus IV abciximab did not enhance myocardial reperfusion in non-selected patients with STEMI undergoing primary PCI after aspiration thrombectomy had successfully been performed.

Efficacy of Intracoronary versus Intravenous Abciximab in Cardiac Inflammatory Markers and Cardiac Function in Myocardial Infarctionn Patients

“…Two recent randomized clinical trials found a similarity between IC and IV abciximab in post-procedural TMI flow grade 3 supporting our finding [15,16]. However, another study realized more myocardial infarction patients experienced TIMI flow grade 3 in IC abciximab but the results were not statistically significant [23].…”

“…A total of 15 randomized controlled trials (RCTs) met our inclusion criteria [5][6][7][8][9][10][15][16][17][18][19][20][21][22][23] . The included studies compared intracoronary versus intravenous abciximab in myocardial infarction after percutaneous coronary intervention.…”

“…In patients with ST-elevation myocardial infarction (STEMI), PCI can be critical to survival as it reduces mortality [2,3]. However, suboptimal myocardial perfusion continues to be a major limitation of PCI [4].…”

Therapeutic Targets for Regulating Oxidative Damage Induced by Ischemia-Reperfusion Injury: A Study from a Pharmacological Perspective

“…In terms of clinical results, patients with acute coronary syndrome have presented with a significant reduction in infarct size [ 274 ]. In addition, intracoronary administration combined with thrombectomy significantly reduced infarct size [ 275 ]. The application of novel therapies in clinical practice is challenging, and there is an extensive list of not favorable outcomes in I-R treatments in clinical trials.…”

Exogenous factors as potential antiplatelet drugs

“…105 Abciximab is indicated for use in patients undergoing primary percutaneous coronary intervention and myocardial ischemia, together with heparin and acetylsalicylic acid. 106 Side effects of abciximab use are thrombocytopenia, bleeding, abdominal pain, nausea and vomiting. 107 Currently, abciximab is in shortage, as listed by the FDA, because of an interruption in manufacturing at a third-party site.…”