Intracoronary versus Intravenous Administration of Abciximab in Patients with Acute Coronary Syndrome: A Meta-Analysis

Abstract

BackgroundAbciximab is a widely used adjunctive therapy for acute coronary syndrome (ACS). However, the effect of intracoronary (IC) administration of abciximab on cardiovascular events remains unclear when compared with intravenous (IV) therapy.Methodology and Principal FindingsWe systematically searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases and reference lists of articles and proceedings of major meetings for obtaining relevant literature. All eligible trials included ACS patients who received either IC administration of abciximab or IV therapy. The primary outcome was major cardiovascular events, and secondary outcomes included total mortality, reinfarction, and any possible adverse events. Of 660 identified studies, we included 9 trials reporting data on 3916 ACS patients. Overall, IC administration of abciximab resulted in 45% reduction in relative risk for major cardiovascular events (RR; 95% confidence interval [CI], 24−60%), 41% reduction in RR for reinfarction (95% CI, 7−63%), and 44% reduction in RR for congestive heart failure relative to IV therapy (95% CI, 8−66%); however, compared to IV therapy, IC administration of abciximab had no effect on total mortality (RR, 0.69; 95% CI, 0.45−1.07). No other significant differences were identified between the effect of IC abciximab administration and IV therapy.Conclusions/SignificanceIC administration of abciximab can reduce the risk of major cardiovascular events, reinfarction, and congestive heart failure when compared with IV therapy.

Management of percutaneous coronary intervention complications

“…Intracoronary bolus tends to be preferred. Intracoronary abciximab has been shown to reduce the risk of major cardiovascular events, reinfarction and congestive heart failure when compared with intravenous therapy 8. Gentle inflation or agitation with a balloon may be required to disperse small thrombi causing distal vessel occlusion.…”

Antiplatelet and anticoagulation therapy during percutaneous coronary interventions: A review for the interventionalist

“…In the largest randomized trial comparing intravenous to intracoronary administration in ACS patients ( n = 105), intracoronary delivery of abciximab bolus was not associated with improved angiographic results, infarct size, and/or clinical outcomes . However, a meta‐analysis of 3916 patients from various trials showed that intracoronary use resulted in 45% reduction in relative risk for major cardiovascular events (RR; 95% confidence interval [CI], 24‐60%), with no effect on overall mortality . Because there are no definitive results, the guidelines currently advise the route of administration be at the operator's discretion (class IIb)…”

“…47 However, a meta-analysis of 3916 patients from various trials showed that intracoronary use resulted in 45% reduction in relative risk for major cardiovascular events (RR; 95% confidence interval [CI], 24-60%), with no effect on overall mortality. 48 Because there are no definitive results, the guidelines currently advise the route of administration be at the operator's discretion (class IIb). 30 The timing of GPI administration was investigated in several trials.…”