Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Cardiol J. 2012;19(3):230-42. doi: 10.5603/cj.2012.0044.
Intracoronary (IC) abciximab administration remains a promising approach aimed to increase a drug concentration in the target area and possibly improve clinical outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of this literature review and meta-analysis is to update available knowledge comparing IC and intravenous (IV) abciximab administration in STEMI patients.
A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and major bleeding complications were the secondary end points.
IC abciximab did not provide any benefits in terms of all-cause mortality as compared with IV abciximab (odds ratio [OR] 0.67; 95% confidence interval [CI] 0.34-1.34). However, this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40-0.92) but the difference disappeared after one of the RCTs was excluded from the analysis. Both strategies were equal regarding TVR (OR 0.66; 95% CI 0.40-1.09) and major bleeding complications (OR 1.18; 95% CI 0.76-1.83).
Our updated meta-analysis shows that the clinical superiority of IC over IV abciximab administration in STEMI patients is no longer clear after the release of the AIDA STEMI trial results. Further research in high-risk STEMI patients is warranted to finally determine clinical advantages of IC vs IV abciximab administration.
冠状动脉内（IC）阿昔单抗给药仍然是一种很有前途的方法，旨在增加目标区域的药物浓度，并可能改善 ST 段抬高型心肌梗死（STEMI）患者的临床结局。本文献复习和荟萃分析的目的是更新目前的知识，比较 STEMI 患者中 IC 和静脉内（IV）阿昔单抗给药。
共纳入 7 项随机临床试验（RCT），中位随访时间为 3 个月，进行荟萃分析（n=3311）。全因死亡率被选为主要终点，而复发性心肌梗死（re-MI）、靶血管血运重建（TVR）和主要出血并发症为次要终点。
与 IV 阿昔单抗相比，IC 阿昔单抗在全因死亡率方面没有任何获益（比值比[OR]0.67；95%置信区间[CI]0.34-1.34）。然而，这种中性效应是由 AIDA STEMI 试验驱动的。与 IV 给药相比，IC 途径与降低 re-MI 发生率相关（OR 0.61；95%CI 0.40-0.92），但在一项 RCT 被排除在分析之外后，差异消失。两种策略在 TVR（OR 0.66；95%CI 0.40-1.09）和主要出血并发症（OR 1.18；95%CI 0.76-1.83）方面是相等的。
我们的更新荟萃分析表明，在 AIDA STEMI 试验结果发布后，IC 优于 IV 阿昔单抗给药在 STEMI 患者中的临床优势不再明确。需要对高危 STEMI 患者进行进一步研究，以最终确定 IC 与 IV 阿昔单抗给药的临床优势。
