Original Studies Comparison of Intracoronary vs. Intravenous Administration of Abciximab in Coronary Stenting Aman K. Kakkar, 1 MD, Ali Moustapha, 1 MD, Henry G. Hanley, 1 MD, Mitchell Weiss, 1 MD, Gloria Caldito, 2 PhD, Praphul Misra, 1 MD, Pratap C. Reddy, 1 MD, and Neeraj Tandon, 1 * MD There have been animal and human studies looking at intracoronary (IC) use of abciximab with good short-term clinical outcomes. There exists no data comparing intracoronary with intravenous (IV) administration of abciximab beyond 30 days. We compared the clinical outcomes between the IC (n  101) and IV (n  72) group of patients. Patients who had coronary stenting and received abciximab were included in the study. All the patients received the standard systemic bolus dose of abciximab 0.25 mg/kg either via the IC or IV route, followed by a 12-hr IV infusion at 0.125 g/kg/min. The 6-month composite endpoint of death or myocardial infarction was slightly higher in the IV (13.9%) than in the IC group (5.9%; P  0.04). The frequency of bleeding complications was similar in both groups. The IC bolus route of abciximab may be superior to the intravenous route. Prospective randomized trials are warranted to validate these findings. Catheter Cardio- vasc Interv 2004;61:31–34. © 2004 Wiley-Liss, Inc. Key words: local delivery; glycoprotein IIb/IIIa inhibitors; stenting; outcomes INTRODUCTION Abciximab is known to improve outcomes in percuta- neous coronary intervention (PCI) [1–3]. It is adminis- tered as an intravenous (IV) bolus followed by a 12-hr infusion. Previous animal studies on intracoronary (IC) abciximab have been associated with intramural deposi- tion of abciximab at the angioplasty site [4] and enhanced lysis of platelet-rich thrombi [5]. The use of intracoro- nary abciximab appears attractive as one is injecting the bolus dose directly into the culprit coronary artery and hopefully gets the maximal antiplatelet effect locally. There have been reports of intracoronary use of nonsys- temic doses of abciximab in human beings in the pres- ence of intracoronary thrombus [6,7]. A recent study [8] showed reduction in the incidence of major adverse car- diac events at 30 days in the patients who received IC bolus dose of abciximab. All of these showed good short-term outcomes. There have been no studies com- paring clinical outcomes of IV with IC administration of a bolus dose of abciximab in PCI beyond 30 days. There exists no data on bleeding complications either. We present a study that compared clinical outcomes of the two different routes, IV vs. IC, of giving bolus doses of abciximab followed by a 12-hr IV infusion. The pri- mary objective of the study was to compare the compos- ite endpoint of death or myocardial infarction (MI) at 6 months in both groups. The secondary objective was to analyze the incidence of immediate major bleeding and 6-month rates of rehospitalization, MI, and target vessel revascularization (TVR) in the two groups. MATERIALS AND METHODS Patient Selection and Procedure Patients were drawn from a consecutively compiled PCI registry from January 2001 to June 2002. Patients who received coronary stent implantation and abciximab were included in the study. The patients who had only balloon angioplasty or did not have 6-month follow-up 1 Department of Medicine, Division of Cardiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 2 Department of Biometry, Louisiana State University Health Sci- ences Center, Shreveport, Louisiana *Correspondence to: Dr. Neeraj Tandon, Division of Cardiology, LSU Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130. E-mail: ntando@lsuhsc.edu Received 15 May 2003; Revision accepted 8 September 2003 DOI 10.1002/ccd.10730 Published online in Wiley InterScience (www.interscience.wiley.com). Catheterization and Cardiovascular Interventions 61:31–34 (2004) © 2004 Wiley-Liss, Inc.