November 13, 2011

November 13, 2011 (Orlando, Florida) — There was no benefit of giving abciximab by an intracoronary (IC) bolus over the normal IV route in the AIDA STEMItrial.

Presenting the data at theAmerican Heart Association 2011 Scientific Sessions, Dr Holger Thiele (University of Leipzig, Germany) noted that the primary end point of the study, a composite of death/new MI/new heart failure at 90 days, was not different between the two groups, but there was a suggestion that new heart failure may be reduced with the IC administration. "However, this might have been due to chance, as there was no difference in ST resolution or infarct size," he added.

Thiele explained that preliminary studies had shown that IC administration of abciximab resulted in higher levels of receptor occupancy and platelet inhibition in the coronary circulation and increased microvascular perfusion. A meta-analysis of smaller trials had suggested that the IC route may be associated with reduced mortality, reduced MI, and reduced target vessel revascularization, but this needed to be confirmed in a single large trial.

For the AIDA STEMI trial, 2065 STEMI patents undergoing PCI were randomized to receive abciximab by an IV infusion or directly into the blocked coronary artery.

Results at 90 days showed no significant difference in the primary end point.

AIDA STEMI: Main Results

End point IC abciximab (%) IV abciximab (%) OR (95% CI) p
Death/MI/HF 7.0 7.6 0.91 (0.91–1.28) 0.58
Death 4.5 3.6 1.24 (0.78–1.97) 0.36
MI 1.8 1.8 1.0 (0.51–1.96) 0.99
HF 2.4 4.1 0.57 (0.33–0.97) 0.04

Discussant of the trial, Dr Alice Jacobs (Boston University Medical Center, MA), noted that the event rate in the study was lower than expected, so it was underpowered to show a difference between the two groups. "We cannot exclude a small difference, but I think this is unlikely, so the IV route of administration should remain the standard of care for abciximab," she concluded.


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