Abstract 20136: Intracoronary Application of Abciximab in ST-Elevation Myocardial Infarction Improves Left Ventricular Function at 6 Months
Background: Abciximab reduces major adverse cardiac events in patients with STEMI undergoing primary 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.
Methods: We enrolled 154 Patients with acute myocardial infarction undergoing primary PCI: Patients were randomly assigned to receive abciximab bolus either intracoronary (n=77) or intravenously (n=77) followed by a 12-hour continuous intravenous infusion. MRI studies of the heart were done in acute phase (2–4 days after acute infarction) and at 6 months follow-up.
Results: In the intracoronary group the left ventricular ejection fraction (LVEF) at 6 months was significantly higher than at baseline (44.0±10.7 vs. 48.3±12.0 %; p<0,001), whereas in the intravenous group only a trend in LVEF-difference was observed (45.3±10.1 vs. 46.9±11.7; p=0.08). In direct comparison the EF-improvement between the two groups reached nearly significance (i.c. +4.3±7.6 vs. i.v. +1.6±6.6; p=0.05) and IC abciximab group patients had significantly less adverse remodelling as compared to standard IV abciximab treatment (p=0.03). The residual necrotic area shown as delayed enhancement at 6 months was also significantly smaller in the intracoronary group (16.7±13.1%LV vs. 24.8±14.4%LV; p=0.002). In a combined endpoint including death, reinfarction, new onset of congestive heart failure and target vessel revascularization there was a trend towards a lower MACE-rate in the intracoronary group (10.7 % vs. 21.7 %, OR 2.3, 95%CI 0.92 to 5.78, p=0.07).
Conclusion: The intracoronary bolus application of abciximab in acute STEMI improves the LVEF and also results in a trend towards a lower MACE-rate in comparison to the standard intravenous treatment.
- Myocardial infarction, STEMI
- Magnetic resonance imaging
- Glycoprotein iib/iiia platelet inhibitors
- © 2010 by American Heart Association, Inc.