AIDA-STEMI Substudy Confirms Original Findings

MIAMI BEACH, FLA.—A substudy of the AIDA-STEMI trial confirms no differences in the combined endpoint of death, reinfarction and new congestive heart failure in patients presenting with ST-elevation myocardial infarction (STEMI) assigned to intracoronary vs. intravenous abciximab during PCI with subsequent 12-hour intravenous infusion. Rates of myocardial damage and/or reperfusion injury also were similar.

In the main AIDA-STEMI trial, 2,065 patients with STEMI were randomly assigned to intracoronary or IV abciximab during PCI. Both treatment methods resulted in similar 90-day rates of all-cause mortality and recurrent or congestive HF. The overall MACE rate at 30-day follow-up was 15.6% for IV abciximab and 5.2% for intracoronary abciximab (RR 3.0; 95% CI 0.94-10.80; P=.06).

For the AIDA-STEMI MRI substudy, researchers pooled data on 795 patients from the main trial who underwent cardiac magnetic resonance imaging (MRI) within 4 days of presenting with STEMI via a standardized protocol of edema imaging and late gadolinium enhancement. Infarct size, myocardial salvage, microvascular obstruction and ventricular function were assessed to compare the outcomes of the intracoronary (n=394) vs. IV (n=401) groups.

Outcomes similar at 1 year

In addition to finding no differences in the combined clinical endpoint between treatment groups at 12 months (see Figure), the myocardial area at risk (P=.97), myocardial salvage index (P=.25) and final infarct size (P=.52) also did not differ. In further detailed analysis, there were no significant differences in microvascular obstruction between the intracoronary and IV groups (47% vs. 52%; P=.19), according to Jochen Wöhrle, MD, of the University of Ulm in Germany.

“AIDA STEMI CMR sub-study confirms the lack of difference in the combined endpoint of death, reinfarction of congestive heart failure of the AIDA STEMI trial,” Wohrle said.