12 Aug Intracoronary Antiplatelet Abciximab Bolus May Improve Outcomes of Primary PCI in STEMI patients with Diabetes
MedicalResearch.com Interview with:
Raffaele Piccolo, MD
Department of Cardiology
Bern University Hospital
University of Bern
MedicalResearch.com: What is the background for this study?
Response: Over the past two decades, the prevalence of diabetes mellitus has doubled in Western countries and future projections are even worse by showing a 55% increase by 2035 when approximately 592 million of people are expected to live with diabetes all over the world.
Acute myocardial infarction still represents the most common diabetes-related complication and its occurrence is associated with a higher risk of mortality. Timely recanalization of the occluded coronary vessel with primary percutaneous coronary intervention (PCI) represents the therapy of choice for acute ST-segment elevation myocardial infarction (STEMI).
Our study investigated whether the direct application of an intracoronary bolus of abciximab, which is an antiplatelet drug blocking the glycoprotein IIb/III a receptor, at the time of primary PCI improves the outcomes at 1-year follow-up compared with the standard intravenous route. The study was in individual patient-level pooled analysis of 3 randomized trials including 2,470 patients, of whom 473 (19%) had diabetes.
MedicalResearch.com: What are the main findings?
Response: The administration of intracoronary abciximab in diabetic patients with STEMI undergoing primary PCI improved the 1-year clinical outcomes by significantly reducing the risk of death or reinfarction. Moreover, diabetic patients who were randomized to the intracoronary bolus presented also a lower risk of stent thrombosis and a higher myocardial salvage at cardiac magnetic resonance. Interestingly, there was no benefit of intracoronary abciximab in patients without diabetes.
MedicalResearch.com: What should readers take away from your report?
Response: Our data suggests that the use of intracoronary abciximab bolus may improve the effectiveness of primary PCI in STEMI patients with diabetes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future studies should be designed specifically for diabetic patients with STEMI and compare the use of intracoronary abciximab against the current standard of care, consisting of primary PCI and novel P2Y12 receptor inhibitors (ticagrelor or prasugrel) without the administration of intravenous glycoprotein IIb/IIIa receptor inhibitors.
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Piccolo R, Eitel I, Galasso G, et al. 1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol. 2016;68(7):727-738. doi:10.1016/j.jacc.2016.05.078
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