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Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis
Giuseppe De Luca1, Harry Suryapranata, Gregg W Stone
1Isala Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
Insights
Abciximab significantly reduces mortality and reinfarction in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty. However, it increases bleeding risk when combined with fibrinolysis.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The clinical benefits of abciximab in ST-segment elevation myocardial infarction (STEMI) remain debated.
- Evidence synthesis is needed to clarify its efficacy and safety in STEMI management.
Purpose of the Study:
- To conduct a meta-analysis of all randomized trials evaluating abciximab in STEMI patients.
- To assess the impact of abciximab on mortality, reinfarction, and bleeding complications.
Main Methods:
- Systematic search of MEDLINE and PubMed databases (1990-2004).
- Inclusion of all completed, published randomized trials for STEMI.
- Data extraction on study design, interventions, patient characteristics, and clinical outcomes.
Main Results:
- Eleven trials with 27,115 patients were analyzed.
- Abciximab reduced short-term (30-day) and long-term mortality in primary angioplasty patients (P=.047 and P=.01, respectively).
- Significant reduction in 30-day reinfarction across all treatment groups (P<.001).
- Increased major bleeding risk observed with abciximab combined with fibrinolysis (P<.001).
Conclusions:
- Adjunctive abciximab therapy in STEMI significantly reduces mortality in primary angioplasty patients.
- Abciximab effectively decreases reinfarction rates regardless of reperfusion strategy.
- Careful consideration of bleeding risk is warranted when using abciximab with fibrinolysis.
Context:
The benefits of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) are still a matter of debate.
Objective:
To combine data from all randomized trials conducted with abciximab in STEMI.
Data Sources:
Formal searches of electronic databases (MEDLINE, PubMed) from from January 1990 to December 2004.
Study Selection:
We examined all completed, published, randomized trials of abciximab in STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, facilitated angioplasty, stenting, fibrinolysis, IIb-IIIa inhibitors, and abciximab.
Data Extraction:
Information on study design, type and dosage of drugs, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by 2 investigators. Disagreements were resolved by consensus.
Data Synthesis:
Eleven trials were analyzed, involving 27115 patients (12,602 [46.5%] in the abciximab group, 14,513 [53.5%] in the control group). When compared with the control group, abciximab was associated with a significant reduction in short-term (30 days) mortality (2.4% vs 3.4%, P = .047) and long-term (6-12 months) mortality (4.4% vs 6.2%, P = .01) in patients undergoing primary angioplasty but not in those treated with fibrinolysis or in all trials combined. Abciximab was associated with a significant reduction in 30-day reinfarction, both in all trials combined (2.1% vs 3.3%, P<.001), in primary angioplasty (1.0% vs 1.9%, P = .03), and in fibrinolysis trials (2.3% vs 3.6%, P<.001). Abciximab did not result in an increased risk of intracranial bleeding (0.61% vs 0.62%, P = .62) but was associated with an increased risk of major bleeding complications when combined with fibrinolysis (5.2% vs 3.1%, P<.001) but not with primary angioplasty (4.7% vs 4.1%, P = .36).
Conclusions:
This meta-analysis shows that, when compared with the control group, adjunctive abciximab for STEMI is associated with a significant reduction in 30-day and long-term mortality in patients treated with primary angioplasty but not in those receiving fibrinolysis. The 30-day reinfarction rate is significantly reduced in patients treated with either fibrinolysis or primary angioplasty. A higher risk of major bleeding complications is observed with abciximab in association with fibrinolysis.
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