Intracoronary versus intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: 6-month effects on infarct size and left ventricular function

Abstract

Intracoronary abciximab application in STEMI patients undergoing PCI is superior to standard IV treatment with respect to infarct size, recovery of LV function and reverse remodelling 6 months after infarction.

Intravenous versus intracoronary bolus of glycoprotein IIb/IIIa inhibitor administration during primary percutaneous coronary intervention on long-term left ventricular systolic and diastolic function

“…Thus, we can be confidant that IC GP IIb/IIIa inhibitor delivery results in improved LVEF 6 months after MI, and this improvement appears to be maintained at 12 months. However, in contrast to our findings, Eitel et al [25] reported no improvement in LVEF if patients were given IV abciximab. This observation by Eitel's group is also at odds against the finding reported by Neumann et al [24] as we discussed earlier.…”

“…Neither IV or IC approach altered the patients' E/E' following primary PCI at 1 year. Second, our longer duration of follow-up of 1 year may have explained some of the differences between our study and that of Eitel et al [25]. We do not have interim 6 months follow-up data for comparison.…”

“…Overall, there was no significant difference between the effects of IC and IV administration of GP IIb/IIIa inhibitors on LV systolic function at 1 year of follow-up. A recent paper by Eitel et al [25] examined 6-month follow-up data of 154 STEMI patients undergoing PCI randomized to either IC or IV abciximab with subsequent 12 hours IV infusion. They found the infarct size as assessed by delayed enhancement MRI was significantly reduced in the IC abciximab group.…”

“…Nevertheless, disappointingly, the incidence of major adverse cardiac events was similar in both groups (5.5% vs. 6.1%, p = 0.786). Eitel et al [25] also noted that although there was MRI evidence of smaller infarct size in the IC group, this did not translate into improvement in event free survival. Thus, there was no significant difference between the 2 strategies in hard outcome such as death, reinfarction or target vessel revascularization at 6 months.…”

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

“…However, to achieve these favorable effects, it is advisable to administer intracoronary abciximab bolus after thrombus penetration by the PCI guidewire, and when the risk of bleeding is an issue, intracoronary bolus of GPI and no infusion strategy may be useful. Some small studies showed infarct size reduction, decrease in microvascular obstruction, improvement in the LVEF, and improvement in myocardial blush, but no significant difference in the clinical outcomes with intracoronary bolus admnistration of abciximab, with and without subsequent infusion [62][63][64][65] . However, meta-analyses published recently, demontrated not only a favorable effect of intracoronary bolus on TIMI flow, but also on target vessel revascularization and short-term mortality after PCI with no increase of bleeding complications [66,67] .…”