Intracoronary Abciximab in Diabetics Undergoing PCI
What are the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in ST-segment elevation myocardial infarction (STEMI) patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary percutaneous coronary intervention (PCI)?
Patient-level data from three randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in one study.
Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. At 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs. 17.6%; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.28-0.83; p = 0.009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs. 7.5%; HR, 0.95; 95% CI, 0.68-1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR, 0.51; 95% CI, 0.26-0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR, 0.27; 95% CI, 0.08-0.98; p = 0.046). At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4; interquartile range [IQR], 35.1-78.2 vs. 39, IQR, 24.7-61.7; p = 0.011; p-interaction vs. no diabetes = 0.016).
The authors concluded that in diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus.
This study reports that intracoronary administration of abciximab improved the 1-year clinical outcomes in STEMI patients with diabetes undergoing primary PCI, with a consistent reduction in the risk of the primary endpoint of death or reinfarction, as well as death and stent thrombosis. This study adds to our existing knowledge of the efficacy of glycoprotein inhibitors in diabetic patients, as most of the evidence supporting their use in STEMI patients, including those with diabetes, was established before the advent of the thienopyridine loading dose. The study findings support current American College of Cardiology/American Heart Association guidelines, which state that intracoronary abciximab be considered for use during primary PCI in selected cases.
Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Magnetic Resonance Imaging
Keywords: Acute Coronary Syndrome, Diabetes Mellitus, Diagnostic Imaging, Glycoproteins, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Metabolic Syndrome X, Myocardial Infarction, Percutaneous Coronary Intervention, Stents, Thienopyridines, Thrombosis, Treatment Outcome
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