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Late-breaking clinical trials from the American Heart Association Scientific Sessions 2011 in Orlando, FL, USA, 13-16 November

2011; Oxford University Press; Volume: 33; Issue: 1 Linguagem: Inglês

10.1093/eurheartj/ehr463

1522-9645

Health Systems, Economic Evaluations, Quality of Life

Intracoronary compared with intravenous bolus abciximab application during primary percutaneous coronary intervention: the abciximab intracoronary vs. intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI) trial Presented by Holger Thiele, Leipzig, GermanyIn a randomized, open-label, multicentre trial, 2065 patients presenting with ST-elevation myocardial infarction (MI) were randomly assigned in a 1:1 ratio to intracoronary vs. intravenous abciximab bolus during percutaneous coronary intervention (PCI) with subsequent 12 h intravenous infusion.The primary efficacy endpoint was the composite of all-cause mortality, recurrent infarction, or new congestive heart failure within 90 days of randomization.Intracoronary, when compared with intravenous abciximab bolus administration, resulted in a similar 90-day rate of the primary composite clinical endpoint [7.0 vs. 7.6%; odds ratio (OR) 0.91; 95% confidence interval (CI) 0.91-1.28;P ¼ 0.58].The incidence of death (4.5 vs. 3.6%; OR, 1.24; 95% CI, 0.78-1.97;P ¼ 0.36) and reinfarction (1.8 vs. 1.8%;OR, 1.0; 95% CI, 0.51-1.96;P ¼ 0.99) did not differ between the treatment groups, whereas less patients in the intracoronary group experienced new congestive heart failure (2.4 vs. 4.1%; OR, 0.57; 95% CI, 0.33-0.97;P ¼ 0.04).In patients with ST-segment elevation MI undergoing primary PCI, intracoronary abciximab when compared with intravenous abciximab did not result in a difference in the combined endpoint of death, reinfarction, or congestive heart failure. Intracoronary stenting and antithrombotic regimen: rapid early action for coronary treatment 4 (ISAR-REACT 4) Presented by Adnan Kastrati, Munich, GermanyBoth abciximab plus heparin and bivalirudin are often used in patients with acute coronary syndromes.However, no direct comparison has been performed between these drugs in dedicated randomized studies enrolling patients with non-ST-segment elevation MI undergoing a PCI.Before PCI, 1721 patients with acute non-ST-segment elevation MI were randomized to abciximab plus unfractionated heparin (861 patients) or bivalirudin (860 patients).The primary composite endpoint was death, large recurrent MI, urgent target-vessel revascularization, or major bleeding within 30 days.It occurred in 10.9% of the abciximab group (94 patients) and in 11.0% of the bivalirudin group (95 patients) (relative risk with abciximab, 0.99; 95% CI, 0.74 -1.32; P ¼ 0.94).Major bleeding occurred in 4.6% of the abciximab group (40 patients) vs. 2.6% of the bivalirudin group (22 patients) (relative risk, 1.84; 95% CI, 1.10 -3.07; P ¼ 0.02).Abciximab and unfractionated heparin failed to reduce the primary endpoint and increased the risk of bleeding.