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AIDA STEMI: Direct administration of abciximab no more effective than IV delivery
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Administering the platelet inhibitor abciximab directly into a blocked coronary artery was no more effective than intravenous delivery in improving overall health outcomes in patients with severe MI, according to results of the late-breaking AIDA STEMI trial.
Researchers randomly assigned 2,065 patients with ST-elevation myocardial infarction (STEMI) undergoing PCI from July 2008 to April 2011 to abciximab by IV infusion or directly into the blocked artery for 12 hours.
The primary endpoint of all-cause death, reinfarction, or new congestive HF at 90 days occurred in 7% of patients assigned to direct administration of abxicimab compared with 7.6% assigned IV. Within 90 days, 2.4% of patients assigned to direct administration were diagnosed with HF compared with 4.1% assigned IV; P=.04).
Although previous research suggested intracoronary dose during PCI could boost concentration of abciximab at the treatment site, limit heart tissue destruction and improve blood flow, the AIDA STEMI researchers did not find a difference in blood flow or infarct size between intracoronary or IV doses between the two routes.
“Intracoronary bolus administration of abciximab does not add a benefit in comparison to the standard IV bolus, with respect to the combined primary study endpoint consisting of death, reinfarction or new congestive HF within 90 days,” Holger Thiele, MD, from the department of internal medicine/cardiology, University of Leipzig-Heart Center, Germany, said at a press conference. The direct administration route may be related to reduced rates of new congestive HF, Thiele said.
In a discussion of the AIDA STEMI trial, Alice Jacobs, MD, director of the cardiac catheterization laboratory and interventional cardiology at Boston Medical Center, said primary PCI for STEMI is performed in more than 90% of patients. “Yet we know that myocardial damage does not cease with epicardial reperfusion and that there remains impaired tissue perfusion and flow to the microcirculation in approximately 70% of patients … which has been associated with adverse outcomes,” she said. “So it’s not surprising that there is an ongoing evaluation of both adjunctive pharmacologic and mechanical agents to improve tissue perfusion and microcirculatory flow.” – by Casey Murphy
For more information:
- Thiele H. Abstract #18633. Presented at:American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
Disclosure: Dr. Thiele reports receiving research grants and is on the speaker’s bureau for Lilly.
While there was no difference in the primary endpoint of death, reinfarction or new congestive HF between groups, intracoronary abciximab was well tolerated and did not increase the risk for arrhythmias, stent thrombosis or bleeding. The findings suggest that intracoronary abciximab administration may be an option when a primary operator believes that a GP IIb/IIIa inhibitor is clinically indicated for patients with suspected STEMI.
– Richard C. Becker, MD
Professor of Medicine
Duke University School of
Medicine
Disclosure: Dr. Becker reports no relevant financial disclosures.
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