Abstract 16028: Intracoronary Compared with Intravenous Bolus Abciximab Application During Primary Percutaneous Coronary Intervention - ST-Segment Resolution Substudy of the AIDA STEMI Trial
The AIDA STEMI trial compared i.c. versus i.v. abciximab bolus during primary PCI in STEMI patients. At 90-day follow-up i.c. as compared to i.v. abciximab resulted in a similar 90-day rate of the primary composite clinical endpoint.1 However, there was a significant reduction in congestive heart failure. A detailed ECG ST-segment resolution analysis is warranted to assess potential benefits of i.c. abciximab on reperfusion.
AIDA STEMI was a randomised, open-label, multicenter trial in 2065 patients presenting with STEMI comparing i.c. versus i.v. abciximab bolus during PCI with subsequent 12 h intravenous infusion. The primary efficacy endpoint was the composite of all-cause mortality, recurrent infarction or new congestive heart failure within 90 days. Secondary endpoint was ST-segment resolution assessed in a core lab using different analysis methods including sum ST-elevation resolution, sum ST-deviation resolution, single worst lead resolution, and single worst lead ST-elevation post PCI.
In total 2065 patients were assigned to i.c. (n=1032) or i.v. abciximab (n=1033). Paired pre and post ST-segment resolution data were available in 1650 patients with no differences the timing of the early (90 min) ECG as well as the 24 hour ECG between treatment groups. There were no significant differences in early ST-segment resolution using the summed ST-segment elevation method (i.c.: median 55.4%; interquartile range 25.0-77.1 versus intravenous: 52.8%; interquartile range 21.4-75.0; P=0.37) or any other above described method. All ST-segment-recovery methods provided strong prognostic information regarding clinical outcomes.
In STEMI patients undergoing primary PCI, i.c. as compared to i.v. abciximab did not result in a difference in the combined endpoint of death, reinfarction or congestive heart failure. None of the detailed ST-segment resolution analytical methods showed a benefit of i.c. abciximab.
- © 2012 by American Heart Association, Inc.