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All rights reserved. doi:10.1016/j.ijcard.2010.02.004 Comparison between fixed-dose, intracoronary bolus-only versus standard weight-adjusted dose, intravenous bolus and infusion administration of abciximab in patients undergoing primary percutaneous coronary intervention Chi-Hang Lee ⁎, Hung M. Ngo, Albert Sewianto, Tran Huy Nguyen, Jieying Lee, Swee-Guan Teo, Adrian F. Low, Huay-Cheem Tan National University Heart Centre, National University of Singapore, Singapore article info Article history: Received 10 December 2009 Accepted 10 February 2010 Available online 15 March 2010 Keyword: Abciximab ST-segment elevation myocardial infarction Bolus ⁎ Corresponding author. Cardiac Department, National University Heart Center, 5, Lower Kent Ridge Road, Singapore 119074. Tel.: +65 6772 2493; fax: +65 6872 2998. E-mail address: mdclchr@nus.edu.sg (C.-H. Lee). The efficacy of abciximab, a monoclonal antibody glycoprotein IIb/ IIIa platelet receptor antagonist, in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myo- cardial infarction (STEMI) has been well proven [1,2]. Traditionally, abciximab is administered as an intravenous bolus (0.25 mg/kg), followed by a 12-hour maintenance infusion (0.125 μg/kg/min). However, high bleeding complication rate, especially with concurrent administration of high-dose unfractionated heparin, has been reported. Furthermore, the high cost involved with the standard regimen remains a major barrier in developing countries. It has also been postulated that with high-dose clopidogrel loading, antiplatelet effect could be achieved rapidly. As a consequence, maintenance infusion of abciximab may be less important. Compared to standard ‘bolus and infusion’, bolus-only adminis- tration of glycoprotein IIb/IIIa inhibitor has been reported to be safe and effective for patients undergoing non-urgent percutaneous coronary intervention [3–5]. Besides, with respect to the route of bolus administration of glycoprotein IIb/IIIb inhibitors, intracoronary administration was found to be more effective, compared to intravenous administration [6]. In this study, we report on the safety and effectiveness of the two approaches of administrating abciximab in patients undergoing primary percutaneous coronary intervention: (1) fixed-dose, intracoronary bolus-only, and (2) weight-adjusted dose, intravenous bolus and infusion. A total of 195 patients who underwent primary percutaneous coronary intervention for STEMI at our institution, and to whom abciximab was administered, were studied. The patients were divided into 2 groups: Group A (n = 120, 61.5%) received fixed-dose, intracoronary bolus-only, abciximab 10 mg; and Group B (n = 75, 38.5%) received standard intravenous bolus (0.25 mg/kg) and main- tenance abciximab infusion of 0.125 μg/kg/min for 12 h. All patients were pretreated with dual antiplatelet therapy loading dose of clopidogrel (300 mg to 600 mg) and aspirin (300 mg). This was followed by one month of maintenance on aspirin 100 mg and clopidogrel 75 mg a day. Low dose weight-adjusted unfractionated heparin of 50 units/kg was administered to Group A, whereas a standard 100 units/kg was administered to Group B. Data were expressed as mean± SD. Differences between all continuous variables were analyzed using the Student's t test with SPSS statistical package, version 13.0 (SPSS inc., Chicago, Ill, USA). The demographic and clinical characteristics of the patients are shown in Table 1 . A total of 14 patients (7.2%) had cardiogenic shock on presentation. Male patients constitute the majority of patients in our study cohort. The ethnic composition of these patients was in accordance with the ethnic composition of Singapore. There is no significant difference in the clinical characteristics between Groups A and B. Cine angiographic images were available for review in all the study population. Triple vessel disease was more prevalent in Group A. Left anterior descending artery was the most common target lesion. Adjunctive thrombus aspiration devices were used in 50.8% (n = 61) and 65.3% (n =49) of patients in Groups A and B, respectively (p =0.05). Intra-procedural activated clotting times for Groups A and B were 293 and 373 s, respectively. Baseline and final TIMI flow are shown in Fig. 1 . There was no statistically significant difference in the baseline and post-procedure TIMI flow between Groups A and B. Final TIMI 3 flow was achieved in 90.0% and 89.3% of the patients in Groups A and B, respectively (p =0.14). Likewise, final TIMI myocardial perfusion grade 2/3 was achieved in 92.5% and 96.0% of the patients in Groups A and B, respectively (p =0.45). All patients were treated with coronary stent implantation. The use of stent was not significantly different between