Intracoronary reopro during percutaneous coronary intervention in acute and stable patient can influence stent thrombosis formation [IRPASST] study

ABSTRACT

In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events [MACE]. Most clinical trials have studied mainly intravenous administration. Intracoronary [IC] bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis [ST]. We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization [TVR]; therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application. This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention [PCI] and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups Group I [n =199] patient received IC bolus of abciximab [reopro] 0.25 microg/kg during the PCI in cath lab. Group II [n =248] received the standard dose of reopro-a bolus intravenous 0.25 micro g/kg and maintenance dose of 0.125 micro g/kg over 12 h. There were no differences between the groups with regard to diabetes mellitus, group I [56%] vs. group II [58%], P = 0.613; ACS, group I [38%] vs. group II [44%], P = 0.175; Dietthylstilbestrol Drug eluted stent [DES] in group I [66.5%] vs. [57.6%] group II, P = 0.056; Bare Metal Stent [BMS] in group I [33%] vs. [40.7%] group II, P=0.093; target vessel revascularization [TRV] was seen in 9 patients [4%] in group I vs. 16 patients [6%] in group II. ST elevation was seen in 4 patients [2%] in group I vs. 7 patients [2.8%] in group II, all presented with STEMI. In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups [56%], especially in Saudi patients. In-stent restenosis [ISR] was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST