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Intracoronary Compared With Intravenous Bolus Abciximab Application During Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: Cardiac Magnetic Resonance Substudy of the AIDA STEMI Trial

https://doi.org/10.1016/j.jacc.2013.01.048Get rights and content
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Objectives

The aim of the AIDA STEMI (Abciximab i.v. Versus i.c. in ST-elevation Myocardial Infarction) cardiac magnetic resonance (CMR) substudy was to investigate potential benefits of intracoronary versus intravenous abciximab bolus administration on infarct size and reperfusion injury in ST-segment elevation myocardial infarction.

Background

The AIDA STEMI trial randomized 2,065 patients to intracoronary or intravenous abciximab and found similar rates of major adverse cardiac events at 90 days with significantly less congestive heart failure in the intracoronary abciximab group. CMR can directly visualize myocardial damage and reperfusion injury, thereby providing mechanistic and pathophysiological insights.

Methods

We enrolled 795 patients in the AIDA STEMI CMR substudy. CMR was completed within 1 week after ST-segment elevation myocardial infarction. Central core laboratory–masked analyses for quantified ventricular function, volumes, infarct size, microvascular obstruction, hemorrhage, and myocardial salvage were performed.

Results

The area at risk (p = 0.97) and final infarct size (16% [interquartile range: 9% to 25%] versus 17% [interquartile range: 8% to 25%], p = 0.52) did not differ significantly between the intracoronary and the intravenous abciximab groups. Consequently, the myocardial salvage index was similar (52 [interquartile range: 35 to 69] versus 50 [interquartile range: 29 to 69], p = 0.25). There were also no differences in microvascular obstruction (p = 0.19), intramyocardial hemorrhage (p = 0.19), or ejection fraction (p = 0.95) between both treatment groups. Patients in whom major adverse cardiac events occurred had significantly larger infarcts, less myocardial salvage, and more pronounced ventricular dysfunction.

Conclusions

This largest multicenter CMR study in ST-segment elevation myocardial infarction patients to date demonstrates no benefit of intracoronary versus intravenous abciximab administration on myocardial damage and/or reperfusion injury. Infarct size determined by CMR was significantly associated with major adverse cardiac events. (Abciximab i.v. Versus i.c. in ST-elevation Myocardial Infarction [AIDA STEMI]; NCT00712101)

Key Words

angioplasty
cardiac magnetic resonance imaging
glycoprotein IIb/IIIa inhibition
infarction
infarct size

Abbreviations and Acronyms

CMR
cardiac magnetic resonance
IQR
interquartile range
LV
left ventricular
MACE
major adverse cardiac event(s)
MO
microvascular obstruction
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

This study was funded by the University of Leipzig-Heart Centre and the University of Leipzig, Clinical Trial Centre Leipzig, which is supported by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) FKZ 01KN1102. Dr. Thiele is a consultant to Eli Lilly & Company and Maquet Cardiovascular; and receives research funding from Eli Lilly & Company, Terumo, Maquet Cardiovascular, and Teleflex Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.