| Intracoronary versus intravenous abciximab administration in STEMI patients: overview of current status and open questions. | |
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MedLine Citation:
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PMID: 21942506 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To perform a systematic review to provide rationale for intracoronary (IC) abciximab administration in patients with ST-segment elevation myocardial infarction (STEMI), to summarize recent studies comparing IC vs. intravenous (IV) abciximab administration in this setting and to define questions that need to be answered in future trials determining the optimal abciximab regimen. METHODS: A search covering the period from January 1993 to June 2011 was conducted by two independent investigators using MEDLINE, CENTRAL and Google Scholar databases. Proceedings from the scientific sessions of ACC, AHA, ESC, TCT and EuroPCR were also considered. RESULTS: IC administration allows one to obtain a much higher concentration of abciximab than IV injection at the culprit lesion. Therefore it is hypothesized that IC abciximab administration provides more efficient GP IIb/IIIa receptor inhibition and more pronounced additional dose-dependent antiplatelet, antithrombotic, and anti-inflammatory effects when compared to the IV route. Numerous observational and randomized studies comparing IC vs. IV abciximab in STEMI patients indicated improvement in different surrogate end points (infarct size, obstruction of coronary microcirculation, ST segment resolution, inflammatory mediators and markers of platelet activation) related to IC administration. The evidence supporting clinical benefits associated with IC injection of abciximab comes from one randomized and several non-randomized trials as most of the studies were underpowered to assess clinical outcomes. No difference in bleeding complications was observed between IC and IV regimens. Issues that need to be addressed in future studies include: the use of IC abciximab in combination with thrombectomy, the role of selective delivery systems, and the necessity of a prolonged IV infusion of abciximab after IC bolus administration. CONCLUSIONS: An accumulating body of evidence suggests the superiority of IC over IV abciximab administration in STEMI patients. However, further trials are warranted to establish the optimal strategy of abciximab treatment in this setting. |
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Authors:
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Aldona Kubica; Marek Kozinski; Eliano Pio Navarese; Grzegorz Grzesk; Aleksander Goch; Jacek Kubica |
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Publication Detail:
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Type: Journal Article; Review Date: 2011-09-26 |
Journal Detail:
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Title: Current medical research and opinion Volume: 27 ISSN: 1473-4877 ISO Abbreviation: Curr Med Res Opin Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-10-17 Completed Date: 2012-06-07 Revised Date: 2013-05-24 |
Medline Journal Info:
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Nlm Unique ID: 0351014 Medline TA: Curr Med Res Opin Country: England |
Other Details:
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Languages: eng Pagination: 2133-44 Citation Subset: IM |
Affiliation:
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Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antibodies, Monoclonal
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administration & dosage*,
therapeutic use Clinical Trials as Topic Humans Immunoglobulin Fab Fragments / administration & dosage*, therapeutic use Infusions, Intravenous Injections, Intra-Arterial Myocardial Infarction / drug therapy* Platelet Aggregation Inhibitors / administration & dosage* Thrombectomy Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; X85G7936GV/abciximab |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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