***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION AND OBJECTIVES It has been clearly demonstrated that abciximab is useful in percutaneous coronary interventions . However , it is not known if intracoronary administration of the initial abciximab bolus improves outcome . Moreover , there may be safety concerns . METHODS The study was a single-center prospect i ve r and omized trial that included all patients undergoing coronary angioplasty involving the use of abciximab . Patients were r and omized to either intracoronary or intravenous administration of the abciximab bolus .  The primary endpoint was the incidence of major adverse cardiac events ( i.e. , death , myocardial infa rct ion , or the need for revascularization ) ; secondary endpoints were hemorrhagic complications and the troponin-I level . RESULTS The study included 137 patients ; 72 received an intracoronary abciximab bolus and 65 , an intravenous bolus . Clinical characteristics and baseline angiographic findings were similar in the two groups . All patients underwent coronary stent implantation . No difference was observed between the intracoronary bolus group and the intravenous bolus group in type of stent used ( drug eluting stent 47.2 % vs 50.8 % , respectively ) , total stent length , or final TIMI flow grade ( 3 vs 2.97 , respectively ) . The intervention success rates were also similar ( 98.5 % vs. 99 % , respectively ) . No complication associated with the administration route was reported . However , the level of the myocardial injury marker troponin I increased significantly in the intravenous bolus group . Clinical follow-up at 1 year did not reveal any difference in the incidence of major adverse cardiac events : 8.5 % in the intracoronary bolus group versus 6.2 % in the intravenous bolus group . CONCLUSIONS Intracoronary administration of an abciximab bolus did not appear to be less safe or effective than intravenous administration . Less post-procedural myocardial damage was observed in the intracoronary bolus group OBJECTIVES The aim of this study was to perform an individual patient-level pooled analysis of r and omised trials , comparing intracoronary versus intravenous abciximab bolus use in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) undergoing primary percutaneous coronary intervention ( PCI ) . BACKGROUND Abciximab represents a cornerstone in the treatment of STEMI patients undergoing primary PCI .  Intracoronary abciximab bolus administration has been proposed as an alternative strategy to the st and ard intravenous route . However , whether intracoronary abciximab effectively improves clinical outcomes compared with st and ard route remains unknown . METHODS Individual data of 1198 patients enrolled in five trials were entered into the pooled analysis . The primary endpoint of the study was the occurrence of all-cause death and reinfa rct ion at 30-day follow-up . Secondary endpoints were all-cause death , reinfa rct ion and target-vessel revascularisation ( TVR ) . RESULTS No significant heterogeneity was found across trials . Compared with the intravenous route , intracoronary abciximab administration significantly reduced the risk of the composite of death and reinfa rct ion ( HR 0.52 , 95 % CI 0.29 to 0.94 ; p=0.03 ) , death ( HR 0.44 , 95 % CI 0.20 to 0.95 ; p=0.04 ) and TVR ( HR 0.53 , 95 % CI 0.29 to 0.99 ; p=0.045 ) , without a significant impact on the risk of reinfa rct ion ( HR 0.54 , 95 % CI 0.24 to 1.21 ; p=0.13 ) . However , after correction for baseline differences , only the composite of death/reinfa rct ion and death remained significant . CONCLUSIONS In STEMI patients undergoing primary PCI , intracoronary abciximab administration , when compared with the intravenous st and ard route , can improve short-term clinical outcomes mainly by reducing the risk of death Background — Abciximab reduces major adverse cardiac events in patients with ST-elevation myocardial infa rct ion undergoing primary percutaneous coronary intervention ( PCI ) . Intracoronary abciximab bolus application results in high local drug concentrations and may be more effective than a st and ard intravenous bolus . Methods and Results — Patients undergoing primary PCI were r and omized to either  intracoronary ( n=77 )  or intravenous ( n=77 )  bolus abciximab administration with subsequent 12-hour intravenous infusion . The primary end point was infa rct size and extent of microvascular obstruction as assessed by delayed enhancement magnetic resonance . Secondary end points were ST-segment resolution at 90 minutes , Thrombolysis in Myocardial Infa rct ion flow and perfusion grade s after PCI , and the occurrence of major adverse cardiac events within 30 days . The median infa rct size was 15.1 % ( interquartile range , 6.1 % to 25.2 % ) in the intracoronary versus 23.4 % ( interquartile range , 13.6 % to 33.2 % ) in the intravenous group ( P=0.01 ) . Similarly , the extent of microvascular obstruction was significantly smaller in intracoronary compared with intravenous abciximab patients ( P=0.01 ) . Myocardial perfusion measured as early ST-segment resolution was significantly improved in intracoronary patients with an absolute ST-segment resolution of 77.8 % ( interquartile range , 66.7 % to 100.0 % ) versus 70.0 % ( interquartile range , 45.2 % to 83.5 % ; P=0.006 ) . The Thrombolysis in Myocardial Infa rct ion flow after PCI was not different between treatment groups ( P=0.51 ) , but there was a trend toward an improved perfusion grade ( P=0.09 ) . There also was a trend toward a lower major adverse cardiac event rate after intracoronary versus intravenous abciximab application ( 5.2 % versus 15.6 % ; P=0.06 ; relative risk , 0.33 ; 95 % CI , 0.09 to 1.05 ) . Conclusions — Intracoronary bolus administration of abciximab in primary PCI is superior to st and ard intravenous treatment with respect to infa rct size , extent of microvascular obstruction , and perfusion Background —In patients with acute myocardial infa rct ion or unstable angina undergoing coronary angioplasty , abciximab reduces major adverse cardiac events ( MACE ) . Clinical trials have studied intravenous administration only . Intracoronary bolus application of abciximab causes very high local drug concentrations and may be more effective . We studied whether intracoronary bolus administration of abciximab is associated with a reduced MACE rate compared with the st and ard intravenous bolus application . Methods and Results —We stratified 403 consecutive patients with acute myocardial infa rct ion or unstable angina undergoing coronary angioplasty according to the type of application of abciximab .  A 20-mg bolus of abciximab was given intravenously in 109 patients and intracoronarily in 294 patients . There were no differences between the groups with regard to diabetes mellitus , cardiogenic shock , successful intervention , or preprocedural and postprocedural TIMI flow . At 30 days , the incidence of MACE ( death , myocardial infa rct ion , urgent revascularization ) was significantly lower in the patients with intracoronary compared with intravenous administration of abciximab ( 10.2 % versus 20.2%;P < 0.008 ) , which was independent from stenting in multivariate analysis . The effect was most pronounced in patients with preprocedural TIMI 0/1 flow ( MACE : intracoronary 11.8 % versus intravenous 27.5 % , P < 0.002 ; n=273 ) . Conclusions —In patients with acute myocardial infa rct ion or unstable angina undergoing emergency coronary angioplasty , intracoronary bolus application of abciximab is associated with a reduction of MACE compared with the st and ard intravenous bolus application of abciximab . Prospect i ve , r and omized trials are warranted to further assess intracoronary application of abciximab Because the clinics in a multiclinic r and omized clinical trial represent neither fixed stratification effects nor r and om classificatory effects , the appropriate analysis of data from such a trial has been the subject of controversy and debate . The following are some of the elements of controversy that are discussed and for which some bases for resolution are proposed . Is it ever valid to ignore the effects of clinics in the analysis ? Is it ever valid to drop clinics from the analysis ? Is a multiclinic clinical trial similar in structure or not to a single-clinic clinical trial in which patients have been stratified on a classificatory factor ? Assuming that clinics will be taken account of in the analysis , should it be the weighted or the unweighted average of within-clinic treatment differences that is to be taken as the best estimate of the overall difference between the treatments ? How should the data be analyzed if there is evidence of treatment-by-clinic interaction BACKGROUND Thrombosis has been implicated as central to the clinical complications of coronary angioplasty ( PTCA ) . Chimeric monoclonal 7E3 Fab ( c7E3 Fab ) is the first of a new class of antiplatelet drugs directed at the platelet glycoprotein IIb/IIIa integrin . This study was performed to determine the pharmacodynamics of c7E3 Fab administration during PTCA and to gain an initial clinical experience with this novel agent . METHODS AND RESULTS The study was a multicenter , open-label , dose-escalation study conducted in two stages . Enrollment included 56 patients scheduled for elective PTCA who were estimated to be at moderate to high risk of sustaining ischemic complications . All patients were given  aspirin and heparin . The study drug was given at least 10 minutes before PTCA . In stage 1 , increasing bolus doses of c7E3 Fab were given to 15 patients ; a bolus dose of 0.25 mg/kg was found to result in blockade of > 80 % of the receptors and reduce platelet aggregation to < 20 % compared with baseline , establishing this dose as that necessary to sufficiently suppress platelet activity . In stage 2 , additional c7E3 Fab was administered by continuous infusion to 32 patients for progressively longer periods of time ( up to 24 hours ) to confirm that platelet inhibition could be maintained with prolonged drug infusion . Also , 9 patients otherwise meeting entry criteria were given placebo . There were no thrombotic events among patients receiving c7E3 Fab .  Overall procedural and clinical success and complication rates as well as rates of bleeding were statistically similar among groups . However , minor bleeding was more frequent with administration of the active drug . CONCLUSIONS The novel antiplatelet agent c7E3 Fab can be administered during PTCA in combination with aspirin and heparin . Suppression of platelet activity is dose dependent and can be maintained for up to 24 hours . Further evaluation will be required to determine the extent of improvement in ischemic complication and restenosis rates and to provide additional insight into the safety profile of this potent monoclonal platelet antibody Objectives : Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infa rct ion ( STEMI ) undergoing primary percutaneous coronary intervention ( pPCI ) improves outcome . Data have suggested that an intracoronary ( IC ) bolus might be superior to the st and ard intravenous ( IV ) administration . We have previously reported reduced short-term mortality and need for target vessel revascularization ( TVR ) with the IC route . We now present long-term data from our r and omized trial on IC versus IV abciximab in pPCI-treated STEMI patients . Methods : A total of 355 pPCI-treated STEMI patients were r and omized to either IC or IV bolus abciximab followed by a 12-hour IV infusion . Patients were followed for 1 year to observe mortality , TVR or myocardial infa rct ion ( MI ) and the combination of these . Results : The two treatment arms ( IV , n = 170 ; IC , n = 185 ) were similar with regard to baseline characteristics . Mortality was reduced from 10 % in the IV group to 2.7 % in the IC group ( p = 0.004 ) . TVR and MI were also reduced with IC administration ( TVR : 14.1 vs. 7.6 % , p = 0.04 ; MI : 11.8 vs. 5.4 % , p = 0.03 ) . Consequently , patients in the IC treatment arm had a relative risk reduction of 55 % for the combined endpoint after 1 year ( p = 0.002 ) compared to the IV treatment arm . Conclusions : In pPCI-treated STEMI patients treated with abciximab , IC bolus administration result ed in a significant reduction in mortality , TVR and MI compared to IV bolus administration Background Administration of abciximab during primary percutaneous coronary intervention ( PCI ) reduces major adverse cardiac events ( MACE ) in patients with ST-elevation myocardial infa rct ion ( STEMI ) .  
    Output:
    
Our up date d meta- analysis shows that the clinical superiority of IC over IV abciximab administration in STEMI patients is no longer clear after the release of the AIDA STEMI trial results .