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
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,
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.