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Abciximab as Adjunctive Therapy to Reperfusion in Acute ST-Segment Elevation Myocardial Infarction: A Meta-analysis of Randomized Trials

Giuseppe De Luca, MD; Harry Suryapranata, MD, PhD; Gregg W. Stone, MD; David Antoniucci, MD; James E. Tcheng, MD; Franz-Josef Neumann, MD; Frans Van de Werf, MD; Elliott M. Antman, MD; Eric J. Topol, MD
JAMA. 2005;293(14):1759-1765. doi:10.1001/jama.293.14.1759.
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Published online

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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Figures

Figure 1. Abciximab and 30-Day Mortality From Fixed-Effects Model
Graphic Jump Location

The size of the data markers (squares) is approximately proportional to the sample size of each treatment group (primary angioplasty or fibrinolysis). CI indicates confidence interval.

Figure 2. Abciximab and Long-Term (6- and 12-Month) Mortality From Fixed-Effects Model
Graphic Jump Location

The size of the data markers (squares) is approximately proportional to the sample size of each treatment group (primary angioplasty or fibrinolysis). CI indicates confidence interval.
*Indicates 6-month follow-up.

Figure 3. Abciximab and 30-Day Reinfarction
Graphic Jump Location

The size of the data markers (squares) is approximately proportional to the sample size of each treatment group (primary angioplasty or fibrinolysis). CI indicates confidence interval.

Figure 4. Funnel Plot of All Studies Included in the Meta-analysis
Graphic Jump Location

Sample size of each study was plotted against the odds ratio for 30-day mortality (primary end point available from all trials). No skewed distribution was observed, suggesting no publication bias.

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