Intracoronary Abciximab in Diabetic  STEMI Patients Questionable Benefit, Proven Harm ∗

Rapid and sustained restoration of antegrade flow through the epicardial coronary artery is the primary goal of current treatment of acute ST-segment elevation myocardial infarction (STEMI). It consists of a combination of mechanical recanalization of the occluded artery with primary percutaneous coronary intervention (PCI) and aggressive antithrombotic therapy, which is directed at preventing thrombus growth, mitigating distal embolization, and preventing thrombosis in the implanted coronary stent. In the early days of PCI, reocclusion of  the reperfused infarct-related artery occurred frequently. In those days, glycoprotein IIb/IIIa inhibitors (GPIs), such as abciximab, substantially reduced recurrent ischemic events when added to early regimens of heparin in conjunction with aspirin (1,2). Unfortunately, these reductions were paralleled by an increase in iatrogenic hemorrhagic complications(2). Over the past decade, refinements in interventional techniques and antiplatelet therapy have significantly reduced the risk of recurrent ischemic events and alleviated the need for platelet inhibition with GPIs. Improved stent technology, characterized by thinner stent struts eluting novel antiproliferative drugs from improved polymers, has reduced the risk of stent thrombosis(3). Moreover, the next-generation P2Y12 inhibitors prasugrel and ticagrelor have significantly reduced recurrent ischemic events, as compared with clopidogrel, in patients with acute coronary syndromes (4,5)....
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research