We performed a meta-analysis of all available clinical trials comparing intracoronary versus intravenous abciximab administration.
At short-term analysis, incidence of MACEs was significantly lower in the IC group than in the IV group (OR = 0.56; 95 % CI 0.35-0.89; p = 0.015). Interestingly, subgroup analysis showed that most benefit was coming from those studies with a main baseline LVEF < 50 % (OR = 0.33 95 % CI 0.18-0.59).
Similarly, long-term incidence of MACEs was significantly lower in the IC group than in the IV group (OR = 0.47; 95 % CI 0.31-0.71; p < 0.001), with most benefit coming from those studies enrolling patients with a main baseline EF < 50 % (OR = 0.38 95 % CI 0.23-0.63 p < 0.001). In addition, long-term incidence of death was also lower in the IC group than in the IV group (OR = 0.42; 95 % CI 0.20-0.86; p = 0.009).
Our meta-analysis provides evidence of a net clinical benefit for intracoronary versus intravenous abciximab administration, with the highest benefit observed in high-risk ACS patients, such as those with reduced baseline LVEF.