Document Detail

Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis.
MedLine Citation:
PMID:  20516508     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence of results from large multicenter, randomized trials, we performed a systematic review and meta-analysis of available studies comparing IC to IV abciximab in these patients.
METHODS: Eight studies were identified, including five randomized trials and three retrospective studies. Data from 2,301 patients, including 997 with ST-segment-elevation myocardial infarction (STEMI) and 1,304 with non-STEMI or unstable angina, were analyzed.
RESULTS: The studies were conducted from 1996-2008, 24% of patients had diabetes and thienopyridine pretreatment was frequently suboptimal, compared to the current standard of care. Pooled analysis of the data demonstrated significantly reduced mortality (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.94; p = 0.028), and a trend toward a reduction of major adverse cardiac events (MACE, OR 0.62, 95% CI 0.38-1.03; p = 0.066) during up to 12 months of follow up with IC compared to IV abciximab. Metaregression analysis of important covariables showed heterogeneity of individual study results because of different follow-up periods and inclusion of patients without STEMI. Subanalyses showed significant MACE reduction after 1 month of follow up, and in studies exclusively composed of patients with STEMI, respectively.
CONCLUSIONS: This first systematic review and meta-analysis of available studies suggests that compared to standard IV administration, IC abciximab can improve clinical outcomes in patients with ACS undergoing PCI, especially patients with STEMI undergoing primary PCI.
Peter Riis Hansen; Allan Iversen; Jawdat Abdulla
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  22     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-02     Completed Date:  2010-09-16     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  278-82     Citation Subset:  IM    
Department of Cardiology P, Gentofte University Hospital, Niels Andersensvej 65, DK-2900 Hellerup, Denmark.
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MeSH Terms
Acute Coronary Syndrome / drug therapy*
Angioplasty, Balloon, Coronary*
Antibodies, Monoclonal / administration & dosage*
Combined Modality Therapy
Coronary Vessels
Drug Administration Routes
Immunoglobulin Fab Fragments / administration & dosage*
Injections, Intra-Arterial
Injections, Intravenous
Platelet Aggregation Inhibitors / administration & dosage*
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; X85G7936GV/abciximab
Comment In:
J Invasive Cardiol. 2010 Jun;22(6):283   [PMID:  20516509 ]

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