| 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. | |
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MedLine Citation:
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PMID: 20516508 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Peter Riis Hansen; Allan Iversen; Jawdat Abdulla |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: The Journal of invasive cardiology Volume: 22 ISSN: 1557-2501 ISO Abbreviation: J Invasive Cardiol Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-02 Completed Date: 2010-09-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8917477 Medline TA: J Invasive Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 278-82 Citation Subset: IM |
Affiliation:
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Department of Cardiology P, Gentofte University Hospital, Niels Andersensvej 65, DK-2900 Hellerup, Denmark. prh@dadlnet.dk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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drug therapy* Angioplasty, Transluminal, Percutaneous Coronary* Antibodies, Monoclonal / administration & dosage* Combined Modality Therapy Coronary Vessels Drug Administration Routes Humans Immunoglobulin Fab Fragments / administration & dosage* Injections, Intra-Arterial Injections, Intravenous Platelet Aggregation Inhibitors / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 143653-53-6/abciximab |
| Comments/Corrections | |
Comment In:
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J Invasive Cardiol. 2010 Jun;22(6):283
[PMID:
20516509
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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