Document Detail


Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.
MedLine Citation:
PMID:  15827315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Giuseppe De Luca; Harry Suryapranata; Gregg W Stone; David Antoniucci; James E Tcheng; Franz-Josef Neumann; Frans Van de Werf; Elliott M Antman; Eric J Topol
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  293     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-13     Completed Date:  2005-04-18     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1759-65     Citation Subset:  AIM; IM    
Affiliation:
Isala Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary
Antibodies, Monoclonal / therapeutic use*
Chemotherapy, Adjuvant
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Myocardial Infarction / drug therapy*,  therapy
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Randomized Controlled Trials as Topic
Survival Analysis
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; X85G7936GV/abciximab
Comments/Corrections
Comment In:
JAMA. 2005 Oct 12;294(14):1760-1; author reply 1761   [PMID:  16219877 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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