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On the use of abciximab in percutaneous coronary intervention

 

Allan Zeeberg Iversen

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Introduction: The present thesis ´On the use of abciximab in percutaneous coronary intervention´ is based on 6 papers concerning the glycoprotein IIb/IIIa inhibitor, abciximab. The thesis is divided into 2 sections. One section concerning a randomized trial comparing intracoronary (IC) with intravenous (IV) abciximab in patients with ST-segment elevation
myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), and one section concerning results from 3 registry studies on the effect of abciximab in distinct subgroups of patients with acute coronary syndrome (ACS).

Optimal administration route of abciximab.
A randomized study

Background: The glycoprotein IIb/IIIa inhibitor, abciximab, is used as an adjuvant anti-platelet therapy in PCI-treated patients suffering from ACS. A subgroup of patients with ACS is those with STEMI treated with pPCI. Recommendations on the use of abciximab in this setting are based on trials showing clinical benefit of IV bolus of abciximab compared to
placebo. However, it has been speculated, that by administering the initial bolus of abciximab IC, a higher local concentration of the drug could be obtained, and this might confer an even more beneficial effect. Firstly, we searched the literature on the subject and found that no large-scaled randomized trials had been published. Most data were derived
from small studies evaluating non-clinical endpoints or were of retrospective design. This overview is published as a review (paper I).

Objectives and methods: In order to investigate if IC administration of bolus abciximab indeed was superior to IV administration, we set up a randomized, open-label, single-center trial. We randomized 355 STEMI patients treated with pPCI between 2006 and 2008 to receive either IC or IV bolus of abciximab.Patients were subsequently contacted for follow-up after 30 days and 1 year, with regards to the endpoints: mortality, need for target vessel revascularization
(TVR), and new myocardial infarction (MI).

Results: Of the 355 patients randomized, 185 received IC bolus and 170 IV bolus of abciximab. The main results are the following: • After 30 days, significantly fewer patients in the IC arm had died or had the need for TVR. We found no difference in the risk of MI. These results are presented in paper II.
• After 1 year, significantly fewer patients in the IC arm had died, had the need for TVR, or had experienced a new MI. These results are presented in paper III.

Conclusion: In the setting of pPCI-treated STEMI patients, IC bolus administration of abciximab is superior to IV bolus administration with respect to mortality, TVR and MI.