Basics: Recent meta-analysis showed benefits of intracoronary abciximab administration compared with intravenous (A-EV). Although the AIDA study showed no such benefit when analyzing the combined endpoints of death, reinfarction and congestive heart failure, it did show a decrease of CHF in isolation over the group receiving intracoronary abciximab. This time, the study authors of AIDA (Lancet 2012, 379, 923-31) reported a substudy in which patients assessed by cardiac magnetic resonance showed the benefit of intracoronary infusion in terms of infarct size, microvascular obstruction and ventricular function.
Methods and Results: 22 centers in Germany were included in the trial, of which 8 participated in this substudy. Images were evaluated by an independent core lab and considered the presence of edema and /or hemorrhage, endocardial margin, microvascular obstruction, infarct area and epicardial margin. The events analyzed included the myocardium at risk area, the percentage of infarcted myocardium infarction rate and the safe myocardium amount. Regarding the baseline characteristics of patients and medications related to the procedure there was no difference between the groups. In all events analyzed there was no difference between the groups, (area of myocardium at risk 35% in both groups, infarct size 16 vs. 17%, p = 0.52, index of safe myocardial 52 versus 50%, p = 0.25, microvascular obstruction 47 vs. 52%, p = 0.19 and bleeding 32 versus 37%, p = 0.19, ejection fraction 51 vs. 50%, p = 0.95 for intracoronary and intravenous groups, respectively).
Conclusions: This study evaluated using MRI in a group of patients with AMI presenting ST elevation, intracoronary and intravenous abciximab infusion were comparable in relation to myocardial damage and reperfusion injury.
Commentary: A priori while evidence exists that speaks in favor of intracoronary via, this study using parameters of tissue does not show any benefit of one path over the other.
Jochen Woehrle.
2012-10-25
Original title: AIDA STEMI MRI: Cardiac MRI Substudy from a Prospective, Randomized Trial of Intracoronary Abciximab in Patients with ST-Segment Elevation Myocardial Infarction
