BACKGROUND: Investigations of glycoprotein (GP) IIb/IIIa inhibition in primary percutaneous coronary intervention (PCI) have suggested the efficacy of abciximab in improving clinical and angiographic outcomes, but sample-size limitations and variability in trial design preclude the ability to generalize these results to a broader patient population. METHODS: Meta-analytic techniques were used to evaluate clinical outcomes from randomized trials comparing GP IIb/IIIa inhibition with placebo or control therapy in primary PCI for acute myocardial infarction (MI). RESULTS: In 3266 patients, treatment with abciximab significantly reduced the 30-day composite end point of death, reinfarction, or ischemic or urgent target-vessel revascularization (TVR; odds ratio [OR], 0.54; 95% CI, 0.40-0.72), with trends toward reduced 30-day death and death or reinfarction. Abciximab resulted in an increased likelihood of major bleeding (OR, 1.74; 95% CI, 1.11-2.72). By 6 months, abciximab significantly reduced the occurrence of death, reinfarction, or any TVR (OR, 0.80; 95% CI, 0.67-0.97), and there were positive trends favoring a decrease in mortality alone and the composite of death or reinfarction. CONCLUSIONS: Treatment with abciximab significantly reduces early adverse ischemic events, a clinical benefit that is maintained at 6-month follow-up. These findings support the use of adjunctive GP IIb/IIIa inhibition in primary PCI.
BACKGROUND: Investigations of glycoprotein (GP) IIb/IIIa inhibition in primary percutaneous coronary intervention (PCI) have suggested the efficacy of abciximab in improving clinical and angiographic outcomes, but sample-size limitations and variability in trial design preclude the ability to generalize these results to a broader patient population. METHODS: Meta-analytic techniques were used to evaluate clinical outcomes from randomized trials comparing GP IIb/IIIa inhibition with placebo or control therapy in primary PCI for acute myocardial infarction (MI). RESULTS: In 3266 patients, treatment with abciximab significantly reduced the 30-day composite end point of death, reinfarction, or ischemic or urgent target-vessel revascularization (TVR; odds ratio [OR], 0.54; 95% CI, 0.40-0.72), with trends toward reduced 30-day death and death or reinfarction. Abciximab resulted in an increased likelihood of major bleeding (OR, 1.74; 95% CI, 1.11-2.72). By 6 months, abciximab significantly reduced the occurrence of death, reinfarction, or any TVR (OR, 0.80; 95% CI, 0.67-0.97), and there were positive trends favoring a decrease in mortality alone and the composite of death or reinfarction. CONCLUSIONS: Treatment with abciximab significantly reduces early adverse ischemic events, a clinical benefit that is maintained at 6-month follow-up. These findings support the use of adjunctive GP IIb/IIIa inhibition in primary PCI.
Authors: Stefanie Schulz; K Anette Birkmeier; Gjin Ndrepepa; Werner Moshage; Franz Dotzer; Kurt Huber; Josef Dirschinger; Melchior Seyfarth; Albert Schömig; Adnan Kastrati; Julinda Mehilli Journal: Clin Res Cardiol Date: 2010-06-27 Impact factor: 5.460
Authors: Youlan L Gu; Marieke L Fokkema; Marthe A Kampinga; Bart J G L de Smet; Eng S Tan; Ad F M van den Heuvel; Felix Zijlstra Journal: Trials Date: 2009-09-28 Impact factor: 2.279
Authors: Juergen Kammler; Alexander Kypta; Robert Hofmann; Klaus Kerschner; Michael Grund; Kurt Sihorsch; Clemens Steinwender; Thomas Lambert; Wolfram Helml; Franz Leisch Journal: Clin Res Cardiol Date: 2008-10-30 Impact factor: 5.460