Intracoronary versus intravenous abciximab bolus in patients with ST-segment elevation myocardial infarction: 1-year results of the randomized AIDA STEMI trial.
To the Editor: In patients with ST-segment elevation myocardial infarction (STEMI), direct intracoronary as compared with standard intravenous bolus administration of the glycoprotein IIb/IIIa receptor antagonist abciximab acutely causes higher local drug concentrations, greater glycoprotein IIb/IIIa receptor occupancy, and enhanced inhibition of platelet aggregation at the site of thrombus and downstream within the coronary capillary bed (1). These effects might exert a protective effect on the myocardial microcirculation at the time of reperfusion. At short-term follow-up (90 days), the largest randomized trial to date (AIDA STEMI [Abciximab Intracoronary Versus Intravenously Drug Application in STEMI]) comparing intracoronary and intravenous abciximab bolus application in patients with STEMI undergoing primary percutaneous coronary intervention (PCI) could not show a significant difference in a compositemajor adverse cardiac events endpoint, mortality, reinfarction, or bleeding between the 2 delivery routes (2). However, there were significantly fewer episodes of new congestive heart failure in patients randomized to intracoronary abciximab bolus administration. The present analysis reports 12 months of clinical results of the AIDA STEMI trial. In brief, AIDA STEMI randomized 2,065 patients with acute STEMI undergoing primary PCI to either intracoronary or intravenous abciximab bolus application with subsequent 12-h intravenous infusion. All patients received dual oral antiplatelet therapy (aspirin and either clopidogrel or prasugrel). The primary endpoint was a composite of all-cause death, reinfarction, or new congestive heart failure at 90 days. For the predefined 12-month follow-up, the primary analysis was performed for all patients who underwent randomization and had follow-up information according to the intention-to-treat principle. Predefined subgroup analyses were performed for patient age, infarct location, Killip class, post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow, time from symptom onset to randomization, and thrombectomy versus no thrombectomy. Exploratory post hoc