Abstract 5607: Intracoronary Compared with Intravenous Bolus Abciximab Application in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Coronary Intervention - 6 Month Follow-Up
Abciximab reduces major adverse cardiac events in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Intracoronary bolus application of abciximab results in high local drug concentrations and was more effective than standard intravenous bolus application for reduction of infarct size, microvascular obstruction (assessed by MRI) and ST-segment resolution at early follow-up. Here the mid-term follow-up data at 6 months are presented. Patients undergoing primary PCI were randomized to either intracoronary (n=77) or intravenous (n=77) bolus administration of abciximab with subsequent 12 hour intravenous infusion. Primary endpoint was infarct size and extent of microvascular obstruction assessed by delayed enhancement MRI at day 2– 4. For mid-term follow-up patients underwent repeated MRI at 6 months to assess infarct size and left ventricular ejection fraction (LV-EF). Furthermore, any major adverse cardiac event was counted. The median infarct size was 15.1% (interquartile range 6.1;25.2) in the i.c. versus 23.4% (interquartile range 13.6;33.2) in the i.v. group (p=0.01). Similarly, the extent of microvascular obstruction was significantly smaller in i.c. in comparison to i.v. abciximab patients (p=0.01) at early measurement. Myocardial perfusion measured as early ST-segment resolution was significantly improved in i.c. patients with an absolute ST-resolution of 77.8% (interquartile range 66.7;100.0) versus 70.0% (interquartile range 45.2;83.5; p=0.006). At baseline there was no difference in left ventricular ejection fraction (46.1% versus 48.0%). However, at 6 month patients in the i.c. group showed a stronger improvement of absolute 6% versus 3% (p=0.04) There was also a trend towards a lower major adverse cardiac event rate after i.c. versus i.v. abciximab application (9.2% versus 19.6%, p=0.06; relative risk 0.35; 95% confidence intervals 0.09 –1.07). Intracoronary bolus administration of abciximab is superior to standard intravenous treatment with respect to infarct size, extent of microvascular obstruction, and perfusion in primary PCI at early follow-up. At mid-term follow-up this results in improved LVEF and a trend towards a reduction in major adverse cardiac event.