The Lancet has featured a study (AIDA STEMI) evaluating Intracoronary administration of an abciximab bolus during a primary percutaneous coronary intervention, compared to intravenous administration. Intracoronary administration of abciximab bolus results in a high local drug concentration, improved perfusion, and reduction of infarct size compared with intravenous bolus application. However, the safety and efficacy of intracoronary versus standard intravenous bolus application in patients with ST-elevation myocardial infarction (STEMI) undergoing this intervention has not been evaluated.

The study involved 2065 patients presenting with STEMI in the previous 12 hours, who were randomised to receive intracoronary abciximab (n=1032) or intravenous abciximab (n=1033) (0.25 mg/kg bodyweight) during percutaneous coronary intervention with a subsequent 12 h intravenous infusion 0.125 mcg/kg per min (maximum 10 mcg/min). The primary endpoint was a composite of all-cause mortality, recurrent infarction, or new congestive heart failure within 90 days of randomisation. Secondary endpoints were the time to occurrence of the primary endpoint, each individual component of that endpoint, early ST-segment resolution, thrombolysis in myocardial infarction (TIMI) flow grade, and enzymatic infarct size.

The following results were reported:

• Intracoronary, as compared with intravenous abciximab, resulted in a similar rate of the primary composite clinical endpoint at 90 days in 1876 analysable patients (7.0% vs. 7.6%; odds ratio [OR] 0.91; 95% CI 0.64—1.28; p=0.58).

• The incidence of death (4.5% vs. 3.6%; 1.24; 0.78—1.97; p=0.36) and re-infarction (1.8% vs. 1.8%; 1.0; 0.51—1.96; p=0.99) did not differ between the treatment groups, whereas less patients in the intracoronary group had new congestive heart failure (2.4% vs. 4.1%; 0.57; 0.33—0.97; p=0.04).

• None of the secondary endpoints or safety measures differed significantly between groups.

The researchers concluded that in “patients with STEMI undergoing primary percutaneous coronary intervention, intracoronary as compared to intravenous abciximab did not result in a difference in the combined endpoint of death, re-infarction, or congestive heart failure. However, since intracoronary abciximab bolus administration is safe and might be related to reduced rates of congestive heart failure the intracoronary route might be preferred if abciximab is indicated.”