One-Year Outcomes With Intracoronary Abciximab Evaluated in Diabetic Patients Undergoing Primary PCI

August 16, 2016—In diabetic patients with ST-segment elevation myocardial infarction (STEMI), the administration of intracoronary abciximab—compared with the intravenous bolus—improved the effectiveness of primary percutaneous coronary intervention (PCI) at 1 year, concluded Raffaele Piccolo, MD, et al in a study published in Journal of the American College of Cardiology (JACC. 2016;68:727–738).

Diabetic patients are at an increased risk for future cardiovascular events after STEMI and administration of an intracoronary abciximab bolus during primary PCI may be beneficial in this high-risk subgroup.

As summarized in JACC, this study sought to report the 1-year clinical outcomes and cardiac magnetic resonance (CMR) findings in STEMI patients with and without diabetes randomized to intracoronary or intravenous abciximab bolus at the time of primary PCI. Patient-level data were pooled from three randomized trials. 

Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. Comprehensive CMR imaging was performed in one study. The primary endpoint was the composite of death or reinfarction.

The investigators reported that at 1 year, the primary endpoint was significantly reduced in diabetic patients randomized to intracoronary abciximab compared with those randomized to intravenous bolus (9.2% vs 17.6%; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.28–0.83; P = .009). The intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs 7.5%; HR, 0.95; 95% CI, 0.68–1.33; P = .77), resulting in a significant interaction (P = .034). 

Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs 11.2%; HR, 0.51; 95% CI, 0.26–0.98; P = .043) and definite/probable stent thrombosis (1.3% vs 4.8%; HR, 0.27; 95% CI, 0.08–0.98; P = .046). 

At CMR (n = 792), the myocardial salvage index was significantly increased only in diabetic patients randomized to intracoronary compared with intravenous abciximab (54.4 [interquartile range, 35.1–78.2] vs 39 [interquartile range, 24.7–61.7]; P = .011; P for interaction vs no diabetes = .016), reported the investigators in JACC.