Diabetic patients have an increased risk of future cardiovascular events after an ST elevation MI. Administration of an intracoronary abciximab bolus during primary PCI could be beneficial for this high risk subgroup of patients.
This study reports one year clinical outcomes and CMR imaging of patients randomized to intracoronary vs. intravenous abciximab during primary PCI. Primary end point was a composite of death or re-infarction.
Of 2,470 patients included in this study, 473 (19%) had diabetes and 1,997 (81%) did not.
At one year, primary end point was significantly reduced in diabetic patients receiving intracoronary abciximab compared to those receiving an intravenous bolus (9.2% vs. 17.6%; HR: 0.49; CI 95%: 0.28 to 0.83; p=0.009).
The intracoronary abciximab bolus did not reduce events in non-diabetics (7.4% vs. 7.5%; HR: 0.95; CI 95%: 0.68 to 1.33; p=0.77).
In diabetic patients, intracoronary abciximab reduced the risk of death (5.8% vs. 11.2%; HR: 0.51; CI 95%: 0.26 to 0.98; p=0.043) and definite/probable thrombosis (1.3% vs. 4.8%; HR: 0.27; CI 95%: 0.08 to 0.98; p=0.046) compared to intravenous abciximab.
The savaged myocardium index by CMR saw a significant increase only in diabetic patients randomized to intracoronary abciximab.
Conclusion
Intracoronary abciximab bolus administration reduces events in diabetic STEMI patients undergoing primary PCI.
Original Title: 1-Year Outcomes with Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention.
Reference: Raffaele Piccolo et al. J Am Coll Cardiol. 2016;68(7):727-738.
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