August 11, 2016
Abciximab (ReoPro; Janssen Biologics) was more effective when administered directly to the hearts of patients with diabetes during primary percutaneous coronary intervention following ST-segment elevation myocardial infarction (STEMI). Researchers published their findings in the Journal of the American College of Cardiology.
The meta-analysis, which compared 1-year outcomes with intracoronary abciximab with intravenous abciximab, included data from 3 randomized trials involving a total 2,470 patients, 19% of whom had diabetes.
Patients with diabetes who received intracoronary abciximab had significantly reduced risk of the primary endpoint of combined death or reinfarction (9.2%) compared with those who received intravenous abciximab (17.6%), researchers reported.
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However, “the intracoronary abciximab bolus did not reduce the primary endpoint in patients without diabetes (7.4% vs 7.5%),” researchers wrote.
Among patients with diabetes, intracoronary abciximab was linked with a significantly reduced risk of death (5.8% vs 11.2%) and stent thrombosis (1.3% vs 4.8%) compared with intravenous abciximab, according to the study. On cardiac magnetic resonance imaging (MRI) scans, patients with diabetes who received intracoronary abciximab had a greater increase in the myocardial salvage index.
While researchers concluded intracoronary abciximab improved the effectiveness of primary percutaneous coronary intervention in patients with diabetes, an accompany editorial in the same issue questioned the findings.
Calling the study “grossly underpowered,” the critics suggested the findings are due more to chance rather than actual benefit, a MedPage Today article reported.
“We will need adequately powered trials randomizing patients with diabetes and STEMI to either intracoronary abciximab or placebo before we can adopt this treatment into clinical practice,” stated an excerpt from the editorial quoted in the MedPage Today report.—Jolynn Tumolo
Piccolo R, Eitel I, Galasso G, et al. 1-year outcomes with intracoronary abciximab in diabetic patients undergoing primary percutaneous coronary intervention [published online ahead of print August 2016]. J Am Coll Cardiol. 2016;68(7):727-738. doi:10.1016/j.jacc.2016.05.078.
Henriques JPS, Kikkert WJ. Intracoronary abciximab in diabetic STEMI patients: questionable benefit, proven harm [published online ahead of print August 2016]. J Am Coll Cardiol.. 2016;68(7):739-741. doi:10.1016/j.jacc.2016.06.014.