Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

BACKGROUND

Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence of results from large multicenter, randomized trials, we performed a systematic review and meta-analysis of available studies comparing IC to IV abciximab in these patients.

METHODS

Eight studies were identified, including five randomized trials and three retrospective studies. Data from 2,301 patients, including 997 with ST-segment-elevation myocardial infarction (STEMI) and 1,304 with non-STEMI or unstable angina, were analyzed.

RESULTS

The studies were conducted from 1996-2008, 24% of patients had diabetes and thienopyridine pretreatment was frequently suboptimal, compared to the current standard of care. Pooled analysis of the data demonstrated significantly reduced mortality (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35-0.94; p = 0.028), and a trend toward a reduction of major adverse cardiac events (MACE, OR 0.62, 95% CI 0.38-1.03; p = 0.066) during up to 12 months of follow up with IC compared to IV abciximab. Metaregression analysis of important covariables showed heterogeneity of individual study results because of different follow-up periods and inclusion of patients without STEMI. Subanalyses showed significant MACE reduction after 1 month of follow up, and in studies exclusively composed of patients with STEMI, respectively.

CONCLUSIONS

This first systematic review and meta-analysis of available studies suggests that compared to standard IV administration, IC abciximab can improve clinical outcomes in patients with ACS undergoing PCI, especially patients with STEMI undergoing primary PCI.