Abciximab During Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Intracoronary, Intravenous, or Not at All?⁎

The intravenous (IV) route is the standard way to administer abciximab to patients during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but pharmacokinetic principles predict that the intracoronary (IC) route would be better. Because of the short half-life of abciximab and its avid binding to multiple integrin types during the first pass through the systemic circulation, less drug may reach exposed IIb/IIIa epitopes on activated platelets within the culprit lesion after IV bolus than after direct IC administration (). Supporting this concept, a small mechanistic study of 16 patients with STEMI () showed that IC abciximab compared with IV abciximab produced immediately higher IIb/IIIa receptor occupancy in platelets sampled in coronary sinus blood (94% vs. 74%). Thirty minutes later, however, no difference in receptor occupancy was seen (93% vs. 92%). Whether IC abciximab can reduce infarct size or improve clinical outcomes has been evaluated in several clinical trials.
Source: Journal of the American College of Cardiology - Category: Cardiology Authors: Tags: Editorial Comment Source Type: research