Intracoronary abciximab administration improved the effectiveness of percutaneous coronary intervention (PCI) in patients with diabetes who had ST-segment elevation myocardial infarction (STEMI) compared with intravenous bolus, according to data recently published in the Journal of the American College of Cardiology.
Raffaele Piccolo, MD, from Bern University Hospital in Bern, Switzerland, and colleagues collected data from 3 randomized trials to determine the 1-year clinical outcomes of 2470 patients STEMI patients with or without diabetes who were randomly assigned to receive intracoronary or intravenous abciximab bolus with PCI.
“The identification of diabetic patients as potential candidates who can benefit to a greater extent from an intracoronary bolus of abciximab during primary PCI may have important implications because diabetes is present in approximately one-third of patients undergoing PCI and conveys a high residual risk after myocardial revascularization,” the authors explained.
They found that death and reinfarction were reduced among diabetic patients who received intracoronary abciximab after 1 year compared with diabetic patients who received intravenous bolus (9.2% vs 17.6%; hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28-0.83; P=.009).
Among patients without diabetes, intracoronary abciximab bolus did not reduce death and reinfarction compared with intravenous abciximab (7.4% vs 7.5%; HR: 0.95; 95% CI: 0.68-1.33; P=.77).
In addition, among diabetic patients, intracoronary abciximab bolus was associated with significantly reduced risk of mortality (5.8% vs 11.2%; HR: 0.51; 95% CI: 0.26-0.98; P=.043) and definite or probable stent thrombosis (1.3% vs 4.8%; HR: 0.27; 95% CI: 0.08-0.98; P=.046) compared with intravenous abciximab bolus.
Among the 792 patients who underwent cardiac MRI, the myocardial salvage index significantly increased only among patients with diabetes who received intracoronary abciximab compared with intravenous abciximab (54.4 [interquartile range: 35.1-78.2] vs 39.0 [interquartile range: 24.7-61.7]; P=.011; P for interaction vs no diabetes=.016).
The authors noted that the study builds on prior findings of early benefit of intracoronary abciximab in this patient population, but also suggests that there may be a cumulative burden of diabetes on adverse cardiovascular events over time. Thus, the statistical significance of less late mortality highlights a potential stipulation of shorter-term assessments on myocardial recovery.
“Our study importantly advances knowledge of the efficacy of GPI [glycoprotein IIb/IIIa receptor inhibitor] in diabetic patients, as most of the evidence supporting their use in STEMI patients, including those with diabetes, was established before the advent of the thienopyridine loading dose,” the authors wrote. “Indeed, a meta-analysis of randomized trials demonstrated no benefit from intravenous GPI in diabetic patients undergoing primary PCI and concomitant thienopyridine loading.”
Piccolo R, Eitel I, Galasso G, et al. 1-Year outcomes with intracoronary abciximab in diabetic patients undergoing primary percutaneous coronary intervention. J Am Col Cardiol. 2016;68(7):727-738. doi: 10.1016.05.078.