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Similar anti-inflammatory effects of intracoronary and intravenous Abciximab during primary percutaneous coronary intervention: a randomized study

Secco, Gioel Gabrio; Sansa, Mara; Rognoni, Andrea; Parisi, Rosario; Fattori, Rossella; Rossi, Lidia; Lazzero, Maurizio; Rolla, Roberta; Bellomo, Giorgio; Bongo, Angelo Sante; Agostoni, Pierfrancesco; Di Mario, Carlo; Lupi, Alessandro

Journal of Cardiovascular Medicine: March 2015 - Volume 16 - Issue 3 - p 189–196
doi: 10.2459/JCM.0000000000000119
Percutaneous coronary interventions

Background: Intracoronary Abciximab administration during primary percutaneous coronary intervention (pPCI) could offer theoretical advantages over the intravenous route. Besides antiplatelet effects, Abciximab can modulate inflammation via cross-reactivity with GPIIb/IIIa, avb3, and aMb2 receptors. The aim of our study was to assess whether the Abciximab administration route could influence its anti-inflammatory effects.

Methods: Eighty-nine consecutive ST elevation myocardial infarction patient candidates for pPCI were randomized to intracoronary (Group A-47 patients) or intravenous (Group B-42 patients) Abciximab bolus administration. The primary endpoint was the extent of inflammation, measured by C-reactive protein (CRP), vascular cell adhesion molecule 1 (VCAM-1) and inter-cellular adhesion molecule 1 (ICAM-1) levels. This study is registered with ClinicalTrials.gov, NCT01757457.

Results: Data are expressed in medians (interquartiles). In both groups, troponin levels were similar [baseline: 0.12 (0.03–0.94) vs. 0.27 (0.07–1.24) ng/ml, P = 0.73; postprocedural: 22.00 (14.75–69.43) vs. 31.96 (8.23–7.20) ng/ml, P = 0.83]. Both groups also showed similar baseline [0.31 (0.14–0.69) vs. 0.22 (0.09–0.59) mg/ml, P = 0.80] and postprocedural CRP levels [2.28 (1.37–4.23) vs. 2.16 (1.15–3.22) mg/dl, P = 0.69], similar baseline [272.5 (224.7–340.8) vs. 262.2 (221.2–306.4) ng/ml, P = 0.33] and postprocedural soluble ICAM-1 levels [281.5 (244.6–337.4) vs. 287.2 (226.9–359.2) ng/ml P = 0.71], and similar baseline [771.6 (620.9–971.0) vs. 748.6 (592.2–838.8) ng/ml, P = 0.30] and postprocedural soluble VCAM-1 levels [785.2 (671.6–947.1) vs. 745.9 (641.1–841.9) ng/ml, P = 0.17]. In-hospital and 6-month event rates were similar in the two groups.

Conclusions: Our study suggests that Abciximab has similar anti-inflammatory effects irrespective of the administration route. It is unlikely that the potential clinical benefits of intracoronary Abciximab can be related to modulation of integrin receptors.

aDepartment of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara

bDivision of Interventional Cardiology, ‘Ospedali Riuniti Marche Nord’, Pesaro

cHospital Cardiology

dClinical Chemistry, ‘Maggiore della Carità’ Hospital, Novara, Italy

eDepartment of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands

fBiomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Correspondence to Gioel Gabrio Secco, Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Corso Mazzini 18, 28100 Novara, Italy Tel: +39 3934333440; fax: +39 0721362292; e-mail: gioel.gabrio.secco@gmail.com

Received 15 October, 2013

Revised 29 March, 2014

Accepted 31 March, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.