Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives

Abstract

Introduction of antiplatelet agents has contributed substantially to improve the outcome of patients with acute coronary syndromes. Meta-analysis of the studies on abciximab administration during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) has clearly confirmed the mortality benefit associated with intravenous bolus and infusion of abciximab compared to placebo. Recently, introduction of new oral P2Y₁₂ inhibitors (prasugrel, ticagrelor), with a faster and more pronounced antiplatelet effect, have decreased the use of abciximab even in patients with STEMI. However, recent studies have shown a delayed onset of antiplatelet effect of new oral antiplatelet drugs in the setting of STEMI, especially in patients with hemodynamic compromise. Thus, the use of abciximab as an intravenous agent should be strongly considered when oral P2Y₁₂ inhibitors might fail or cannot be given before primary PCI for STEMI. An additional benefit of abciximab administration was reported when abciximab was given early, before primary PCI, compared to typical periprocedural use. To the contrary, no clear clinical benefit was confirmed for intracoronary administration of abciximab compared with intravenous administration. Future studies should focus on the role of abciximab given on top of new oral P2Y₁₂ inhibitor (prasugrel, ticagrelor) or used as an alternative to an intravenous P2Y₁₂ inhibitor (cangrelor). Undoubtedly, the results of these studies will change everyday practice of STEMI treatment.

Keywords:

• glycoprotein IIb/IIIa inhibitors
• acute myocardial infarction
• percutaneous coronary intervention

Disclosure

Dariusz Dudek received a research grant as principal investigator of the EUROTRANSFER Registry and speaker fees from Eli Lilly and Company. Artur Dziewierz, and Tomasz Rakowski received travel grants and speaker fees from Eli Lilly and Company. The authors report no other conflicts of interest in this work.