Abstract 4718: Intracoronary Compared to Intravenous Bolus Abciximab During Percutaneous Coronary Intervention Reduces 30-days Mortality and Target Vessel Revascularisation. A Randomised Trial
Background The positive effect of the glycoprotein IIb/IIIa receptor inhibitor Abciximab in percutaneous coronary intervention (PCI) is widely accepted. However, the optimal route of administration of the initial bolus, i.e. intravenous (IV) vs. intracoronary (IC), has been questioned. Preliminary studies suggest IC bolus, probably due to high local concentration of the drug. We present 30-days follow up data in a randomised trial comparing IV to IC bolus administration of Abciximab during PCI.
Methods We randomised 452 patients who underwent PCI and had indication for adjuvant treatment with Abciximab to either IV or IC bolus followed by a 12-hour IV infusion. Death, myocardial infarction (MI) and target vessel revascularisation (TVR) were recorded in-hospital and after 30 days. Subgroup analyses on 355 STEMI patients were performed.
Findings The two groups (IV n=220; IC n=232) were similar with respect to baseline demographics, clinical presentation, and angiographic findings. Mortality after 30 days were 5·0% in the IV group compared to only 0·9% the IC group (p=0·01). In 8·2% TVR was performed in the IV group compared to only 3·0% in the IC group (p=0·01). A trend towards reduction in MI-rates (IV 5·5% vs. IC 2·6%; p=0·12) was seen. Composite end-point (death, TVR and MI) was reduced from 10·5% in the IV group to 4·7% in the IC group (p=0·02). Subgroup analyses on STEMI patients undergoing primary PCI (IV n=170; IC n=185) showed similar results for death (IV 5·3% vs. IC 1·1%; p=0·02), TVR (IV 9·4% vs. IC 3·8%; p=0·03) and MI (IV 4·7% vs. IC 2·7%; p=0·32), and for the composite end-point (IV 10·0% vs. IC 5·4%; p=0·10). Bleeding complications and platelet counts were similar.
Interpretation IC administration of bolus Abciximab during PCI reduces short term mortality and TVR, but not MI compared to IV bolus administration, also in the setting of primary PCI in STEMI patients.