Effects on mortality of abciximab in ST-elevation myocardial infarction treated with percutaneous coronary
P Tornvall1, T Nilsson, B Lagerqvist
1Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. per.tornvall@karolinska.se
Insights
Abciximab use in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) with stent implantation reduced reinfarction and revascularization risks. While not impacting 30-day mortality, registry data suggest a long-term survival benefit.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt intervention.
- Percutaneous coronary intervention (PCI) with stent implantation is a primary treatment for STEMI.
- The role of abciximab, a glycoprotein IIb/IIIa inhibitor, in STEMI patients undergoing PCI needs further clarification.
Purpose of the Study:
- To evaluate the impact of abciximab on mortality in STEMI patients treated with PCI and stent implantation.
- To analyze the effects of abciximab on reinfarction and urgent target vessel revascularization.
Main Methods:
- A meta-analysis of three randomized controlled trials involving 1,736 patients.
- Analysis of data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) including 7,436 STEMI patients treated with PCI.
Main Results:
- Abciximab was associated with a reduced risk of reinfarction (OR 0.38) and urgent target vessel revascularization (OR 0.38) at 30 days in pooled data.
- No significant effect on 30-day or 6-month mortality was observed in the pooled analysis.
- Multivariate analysis of SCAAR data indicated that abciximab reduced the risk of death during 14 months of follow-up (HR 0.82).
Conclusions:
- The findings support current recommendations for using abciximab in STEMI patients undergoing PCI with stent implantation.
- Encouraging results warrant new, adequately powered randomized trials to further investigate abciximab's long-term effects on mortality in STEMI.
- The study highlights the need for robust evidence to confirm the observed survival benefit in registry data.
Objectives:
To investigate the effects of abciximab on mortality in ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) including stent implantation.
Design:
Meta-analysis of three selected randomized studies and analysis of data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
Subjects:
Pooled data from randomized studies containing in total 1,736 patients undergoing PCI with stent implantation because of STEMI with duration between symptom and treatment <12 h, and 7,436 patients from SCAAR treated with PCI because of STEMI (52% treated with abciximab) in Sweden 2000-2004.
Results:
Analyses of pooled data showed that abciximab was associated with a decreased risk of reinfarction [odds ratio (OR) 0.38] and urgent target vessel revascularization (OR 0.38) at 30 days. No effect was seen on mortality at 30 days or 6 months. Multivariate analysis of data from SCAAR showed that abciximab reduced the risk of death during 14 months of follow-up (hazard ratio 0.82).
Conclusions:
The results are encouraging and support the ACC/AHA and ESC recommendation to use abciximab in treatment of STEMI with PCI including stent implantation. Considering that the pooled results from previous trials showed no effect of abciximab on mortality and the registry part of the present study was observational, the results encourage carrying out new randomized studies of abciximab in STEMI treated with PCI, including stent implantation, with sufficient size and length of follow-up.
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