Abstract 16517: Intracoronary Compared with Intravenous Bolus Abciximab Application During Primary Percutaneous Coronary Intervention - Cardiac Magnetic Resonance Imaging Substudy of the Aida Stemi Trial

Abstract

Background: The AIDA STEMI trial was a randomised, open-label, multicenter trial in 2065 patients presenting with ST-elevation myocardial infarction (STEMI) comparing intracoronary (IC) versus intravenous (IV) abciximab bolus during PCI with subsequent 12h intravenous infusion. At 90-day follow-up IC as compared to IV abciximab resulted in a similar 90-day rate of the primary composite clinical endpoint of all-cause mortality, recurrent infarction or new congestive heart failure. However, there was a significant reduction in congestive heart failure and an observed benefit in women in the IC abciximab group. Cardiac MRI enables investigation of mechanistic and pathophysiological effects of IC abciximab application on myocardial damage and reperfusion injury.

Aim of the AIDA CMR substudy was to determine potential benefits of IC abciximab application on infarct size, the salvaged area at risk, microvascular obstruction, and LV ejection fraction.

Methods: We enrolled 703 patients as part of the AIDA-STEMI trial in this CMR substudy at 7 centers. The CMR was completed within 4 days after infarction using a standardized CMR protocol including edema imaging and late gadolinium enhancement. Central core lab-masked analyses for quantified LVEF, volumes, infarct size, microvascular obstruction and myocardial salvage were performed. The amount of myocardium at risk and final infarct size (17.9±12.9%LV versus 18.3%±12.0%LV, p=0.34) did not differ significantly between the IC versus IV abciximab group. Consequently, the myocardial salvage index was similar between groups (50.2±26.5 versus 47.1±27.6, p=0.16). In further detailed CMR analysis there were no differences in microvascular obstruction (1.5±2.8%LV versus 1.5±2.6%LV, p=0.50), or LV ejection fraction (49.7±11.2% versus 50.3±10.4%, p=0.76) between both treatment groups.

Conclusions: This largest multicenter CMR study in acute reperfused STEMI patients to date demonstrates that IC as compared to IV abciximab did not result in a difference in infarct size, myocardial salvage, LV function or extent of no-reflow confirming the lack of difference in the combined endpoint of death, reinfarction or congestive heart failure