1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

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• 作者：Raffaele Piccolo ; MD^a ; ^{Raffaele.Piccolo@insel.ch" class="auth_mail" title="E-mail the corresponding author} ; Ingo Eitel ; MD^b ; Gennaro Galasso ; MD ; PhD^c ; Alberto Dominguez-Rodriguez ; MD^d ; Allan Zeeberg Iversen ; MD^e ; Pedro Abreu-Gonzalez ; MD^f ; Stephan Windecker ; MD^a ; Holger Thiele ; MD^b ; Federico Piscione ; MD^c
• 关键词：diabetes mellitus ; myocardial infarction ; myocardial revascularization ; STEMI
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：16 August 2016
• 年：2016
• 卷：68
• 期：7
• 页码：727-738
• 全文大小：1556 K

文摘

Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.

d="absSec_2">Objectives

d="abspara0015">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.

d="absSec_3">Methods

d="abspara0020">Patient-level data from 3 randomized trials were pooled. The primary endpoint was the composite of death or reinfarction. Comprehensive CMR imaging was performed in 1 study.

d="absSec_4">Results

d="abspara0025">Of 2,470 patients, 473 (19%) had diabetes and 1,997 (81%) did not. 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 to 0.83; p = 0.009). 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 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). 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 to 0.98; p = 0.043) and definite/probable stent thrombosis (1.3% vs. 4.8%; HR: 0.27; 95% CI: 0.08 to 0.98; p = 0.046). 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 to 78.2 vs. 39.0, interquartile range: 24.7 to 61.7; p = 0.011; p for interaction vs. no diabetes = 0.016).

d="absSec_5">Conclusions

d="abspara0030">In diabetic patients with STEMI, the administration of intracoronary abciximab improved the effectiveness of primary PCI compared with the intravenous bolus.